All PlansCoverageMedium impact
Newsletter Vol. 21, No.15
New Jersey Medicaid·NJ·Pharmacy
We identified it
Jun 20, 2026
Summary
Changes to Fee-For-Service drug coverage and reimbursement policies have been implemented, affecting how pharmacy-related services are billed and reimbursed. This policy update impacts drug coverage criteria and payment structures for FFS arrangements.
Action Required
Immediately: Review Newsletter Vol. 21, No.15 at https://www.njmmis.com/documentDownload.aspx?document=21-15.pdf to understand specific changes to Fee-For-Service drug coverage and reimbursement. Billing team must identify affected drug-related billing codes and update billing procedures accordingly. Contact payer representatives if clarification is needed on new coverage criteria.