MedicaidCoverageHigh impact
Senior Services News Vol. 13, No. 02
New Jersey Medicaid·NJ · Pharmacy, Infectious Disease·Pharmacy
Effective date
Aug 1, 2010
We identified it
Jun 20, 2026
Summary
Effective August 1, 2010, the AIDS Drug Distribution Program (ADDP) will exclude coverage for vitamins, cough/cold medications, erectile dysfunction drugs, and cosmetic drugs (baldness and weight loss treatments). Additionally, ADDP eligibility is now limited to individuals below 300% of the federal poverty level, with specific income limits based on family size.
Action Required
By July 31, 2010: Pharmacy billing team must update billing system edits to deny claims for excluded drug classes (vitamins, cough/cold medications, erectile dysfunction drugs, cosmetic drugs for baldness/weight loss) submitted under ADDP. Update claim rejection rules to reference the new exclusion list. By August 1, 2010: Verify patient eligibility against the new ADDP income limits table (1 person: $32,490; 2 persons: $43,710; 3 persons: $54,930; 4 persons: $66,150; 5 persons: $77,370). Do not process ADDP claims for patients above 300% federal poverty level. Communicate exclusions to prescribing physicians, Advanced Practice Nurses, and Nurse Midwives. Flag any claims with service dates on or after August 1, 2010 that contain excluded drugs for denial with appropriate remittance advice codes. Failure to implement these changes will result in improper claim processing and potential overpayments.