MedicaidReimbursementHigh impact
Newsletter Vol. 19, No. 05
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Jan 12, 2009
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid updated Maximum Allowable Cost (MAC) drug pricing for 30+ generic and brand-name medications, effective January 12, 2009. Hydroxyzine Hydrochloride syrup MAC was suspended entirely. Most drugs received price decreases; some received increases. Billing teams must update their pharmacy pricing tables to reflect new reimbursement limits to avoid claim denials or improper payments.
Action Required
By January 12, 2009 (retroactive - apply immediately if not yet implemented): Billing and pharmacy teams must update Medicaid MAC pricing tables in billing software for all 30+ affected medications listed in this newsletter. For Hydroxyzine Hydrochloride 10 MG/5ML Syrup: Remove from MAC-eligible drugs and route claims to manual review or deny with explanation of suspended coverage. For all other listed drugs: Input the new MAC prices into the system (both price decreases and increases). Verify pharmacy claims processing logic reflects updated prices before processing claims with service dates on/after January 12, 2009. Failure to update pricing will result in incorrect reimbursement, claim denials, or overpayments on New Jersey Medicaid pharmaceutical claims.