MedicaidReimbursementHigh impact
Newsletter Vol. 19, No. 41
New Jersey Medicaid·NJ · Pharmacy·Reimbursement
Effective date
Jun 13, 2009
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid updated Maximum Allowable Cost (MAC) drug pricing effective June 13 and July 17, 2009. Two generic drugs (Erythromycin 2% topical solution and Verapamil 40 mg tablet) were suspended from the MAC list. Multiple drugs received price increases (Carbamazepine, Isosorbide Mononitrate, Lactulose, Propranolol), price decreases (Cilostazol, Meloxicam, Meperidine, Metformin, Mirtazapine, Tramadol, Atenolol, and others), and new extended-release formulations were added (Metformin ER, Topiramate).
Action Required
By June 13, 2009: Billing team must immediately update pharmacy billing system with new MAC prices for all listed drugs, effective the specified dates (6/13/09 and 7/17/09). Remove suspended products (Erythromycin 2% topical solution 60 mL and Verapamil 40 mg tablet) from claims processing to prevent claim denials. Input all price increases and decreases into billing software to ensure accurate reimbursement calculations for Medicaid claims. Verify Metformin extended-release formulations and Topiramate tablets are properly configured in the system as new additions. Communicate changes to clinical staff regarding product availability changes. Notify patients on affected medications if formulary alternatives are needed due to MAC suspensions. Failure to update pricing will result in claim rejections and underpayment for increases or overpayment denials for decreases.