MedicaidCoverageHigh impact
Newsletter Vol. 18, No. 14
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Apr 1, 2006
We identified it
Jun 20, 2026
Summary
Federal law (Section 6033 of the Deficit Reduction Act of 2005) prohibits Medicaid from reimbursing pharmacies twice for the same covered outpatient drug. Pharmacies must prevent duplicate claims submission and adjust or refund any payments already received for restocked drugs using the MMIS Claim Adjustment Request Form (FD-999).
Action Required
Immediately (ongoing since April 1, 2006): Pharmacy billing team must implement controls to prevent duplicate Medicaid claims submission for covered outpatient drugs. For any restocked drugs where Medicaid payment was already received, submit a MMIS Claim Adjustment Request Form (FD-999) or remit appropriate reimbursement to the New Jersey Division of Medical Assistance and Health Services. Verify that billing system flags drugs as previously paid before processing new claims. Do NOT apply this rule to PAAD or Senior Gold program drugs. Failure to comply may result in overpayment recoupment and potential compliance audits.