MedicaidReimbursementHigh impact
Newsletter Vol. 19, No. 16
New Jersey Medicaid·NJ · Pharmacy·Reimbursement
Effective date
Mar 31, 2009
We identified it
Jun 20, 2026
Summary
New Jersey updated the Federal Upper Limits (FUL) for Maximum Allowable Cost (MAC) drugs effective March 31, 2009. This revised APPENDIX B listing replaces the previous MAC drug list and establishes new reimbursement limits for multiple-source generic drugs covered under Medicaid FFS, NJ FamilyCare, and other state assistance programs. Billing teams must update their pharmaceutical services manuals and systems to use the new pricing limits to avoid claim denials.
Action Required
By March 31, 2009: Pharmacy billing team and providers must immediately replace the old MAC drug list (APPENDIX B) with the new revised list (Rev. 3/31/2009) in the Pharmaceutical Services Manual. Update billing software and pharmacy systems to reflect the new Federal Upper Limit pricing for all generic drugs listed in the new APPENDIX B. Verify that claims submitted for Medicaid FFS, NJ FamilyCare FFS, General Assistance, AIDS Drug Distribution Program, Cystic Fibrosis, PAAD, and Senior Gold programs use the updated MAC limits. Discard all previous MAC drug list versions to prevent billing with outdated pricing. Failure to implement the new limits will result in claim denials and payment reductions for drugs billed above the new FUL thresholds. Contact Unisys Provider Relations at (800) 776-6334 with questions.