MedicaidCoverageMedium impact
Newsletter Vol. 15, No. 16
New Jersey Medicaid·NJ · Pharmacy, Endocrinology, Urology +2 more·Medical Policy
Effective date
Jan 1, 2006
We identified it
Jun 20, 2026
Summary
Effective January 1, 2006, NJ FamilyCare/Medicaid will no longer provide prescription drug coverage for erectile dysfunction (ED) drugs. This change implements a federal law prohibition on State Medicaid coverage of ED medications. Billing teams must stop processing ED drug claims for NJ Medicaid beneficiaries and communicate non-coverage to patients and providers.
Action Required
By December 31, 2005: Billing team must update NJ Medicaid billing system to deny or reject all ED drug claims effective January 1, 2006. Notify in-house providers and pharmacy partners of the coverage elimination. Update patient communication materials and prior authorization protocols to reflect non-coverage. Flag any ED drug claims submitted after January 1, 2006 for rejection with reason code indicating non-covered service. Coordinate with pharmacy partners to prevent dispensing ED drugs under NJ FamilyCare/Medicaid. Failure to implement this change will result in claim denials and potential compliance issues with state Medicaid.