MedicaidPrior AuthMedium impact
Newsletter Vol. 16, No. 09
New Jersey Medicaid·NJ · Pediatrics, Family Medicine, Internal Medicine +2 more·Prior Authorization
Effective date
Sep 1, 2005
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid implemented prior authorization requirements for three specific scenarios: Synagis injections for RSV prevention in high-risk infants, therapeutic duplication of second-generation antihistamines from different prescribers, and drug interactions between Symlin and GI motility drugs. All prior authorizations must be obtained through the Medical Exception Process unit.
Action Required
Pharmacy and billing teams must obtain prior authorization from New Jersey's Medical Exception Process unit at (877) 888-2939 for: 1) Synagis injections for eligible infants during RSV season (Nov 1 - Apr 30), 2) Second-generation antihistamines when prescribed by different providers, and 3) Symlin when used with GI motility drugs. Update pharmacy systems to flag these scenarios and train staff on authorization requirements.