MedicaidCoverageHigh impact
Newsletter Vol. 18, No. 13
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 reimbursement for covered outpatient drugs if the pharmacy has already received Medicaid payment for the same drug. New Jersey pharmacies providing services to long-term care facilities must prevent duplicate claims and adjust or refund any overpayments using the FD-999 form.
Action Required
Immediately and ongoing: Billing and pharmacy teams must implement controls to prevent duplicate Medicaid claims for covered outpatient drugs in long-term care settings. (1) Review all current and pending claims for restocked drugs already paid by Medicaid. (2) Submit MMIS Claim Adjustment Request Forms (FD-999) for any duplicate payments identified, or remit reimbursement to the Division of Medical Assistance and Health Services. (3) Update pharmacy billing system and claims submission procedures to flag and prevent resubmission of drugs for which Medicaid payment has already been received. (4) Train pharmacy and billing staff on the requirement. (5) Exclude PAAD and Senior Gold reimbursements from this restriction—duplicate prevention applies only to Medicaid-funded claims. Failure to comply will result in claims being denied and overpayments owed to the state.