MedicaidAdministrativeHigh impact
Newsletter Vol. 21, No.14
New Jersey Medicaid·NJ·Pharmacy
Effective date
Jul 1, 2011
We identified it
Jun 20, 2026
Summary
New Jersey is transferring responsibility for prescription drug coverage from the state to HMOs for NJFC/Medicaid beneficiaries enrolled in managed care. HMOs will now cover all pharmacy claims except Methadone for substance abuse treatment, with additional beneficiary groups being enrolled in managed care starting July 1, 2011.
Action Required
By July 1, 2011: Billing team must update pharmacy claim submission processes to route all prescription claims (except Methadone for substance abuse) to the patient's HMO instead of the state fiscal agent for NJFC/Medicaid managed care beneficiaries. Update billing system to verify HMO enrollment status using REVS system at 1-800-676-6562 or eMEVS at www.njmmis.com before submitting pharmacy claims. Review HMO formularies from provided websites to ensure covered medications. Claims submitted to wrong payer will be denied.