MedicaidReimbursementHigh impact
Newsletter Vol. 19, No. 53
New Jersey Medicaid·NJ · Pharmacy·Reimbursement
Effective date
Oct 26, 2009
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has updated Federal Upper Limits (FUL) for maximum allowable cost (MAC) drugs, effective October 26, 2009. Multiple generic medications have reduced reimbursement rates, and two new drug products (Bicalutamide and Cephalexin suspension) have been added to the MAC formulary. Billing teams must update pharmacy billing systems to reflect these new MAC prices to avoid claim denials or payment adjustments.
Action Required
By October 26, 2009: Pharmacy billing team must update all MAC drug pricing tables in the billing system with the revised FUL prices listed in this newsletter. Specifically: (1) Update downward reimbursement rates for Benztropine Mesylate (0.5mg, 1mg, 2mg tablets), Carbamazepine (200mg tablet), Cephalexin capsules (250mg, 500mg), Cyclobenzaprine HCl (5mg, 10mg tablets), Diclofenac Potassium (50mg tablet), Hydrochlorothiazide (25mg, 50mg tablets), and Ranitidine HCl (syrup and tablets at multiple strengths); (2) Add new MAC entries for Bicalutamide (50mg tablet at $3.4802) and Cephalexin suspension (250mg/5ml at $0.1818). Update pricing in pharmacy software and transmit to all dispensing locations. Verify claims processing reflects new limits to prevent overpayment recoupment. Retain this newsletter for reference during audits.