MedicaidCoverageHigh impact
Newsletter Vol. 20, No.24
New Jersey Medicaid·NJ · Oncology, Hematology·Medical Policy
Effective date
Sep 25, 2010
We identified it
Jun 20, 2026
Summary
Effective immediately (Sept 25, 2010), New Jersey General Assistance (GA) program no longer covers Alimta (J9305) and Gemzar (J9201) chemotherapy drugs. All GA claims for these codes submitted on or after September 25, 2010 will be denied with Error Code 1216. Providers must consider alternative chemotherapy treatments for GA beneficiaries and utilize the Medical Exception Process (MEP) for coverage confirmation of alternative therapies.
Action Required
Immediately: (1) Billing team must update billing system to deny all GA claims for HCPCS codes J9305 and J9201 with service dates on or after September 25, 2010, generating Error Code 1216. (2) Notify all prescribers and oncology staff that Alimta and Gemzar are no longer covered under GA program; alternative chemotherapy must be considered for GA beneficiaries. (3) Update clinical protocols and formularies to reflect this coverage exclusion. (4) For claims already denied, contact DMAHS Chief, Pharmaceutical Services at 609-588-3062. (5) For questions, contact Molina Healthcare Solutions MEP Unit at 1-877-882-2939 or Provider Services at 1-800-766-6334. For prior coverage questions on claims before notification, contact Chief, Pharmaceutical Services at 609-588-3062.