MedicaidReimbursementMedium impact
Newsletter Vol. 14, No. 43
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Mar 20, 2004
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid updated Maximum Allowable Cost (MAC) pricing for multiple generic and brand-name drugs effective March 20, 2004. Changes include: suspension of MAC for 6 drug products (no longer available at FUL pricing), price decreases for 3 drugs, price increases for 10 drugs, and addition of 10 new drugs to the MAC list. Billing teams must update reimbursement rates in claims processing systems to reflect new MAC prices.
Action Required
By March 20, 2004: Billing team must update all pharmacy claim processing systems with new MAC prices for affected drugs. (1) SUSPEND billing for: Bisoprolol Fumarate/Hydrochlorothiazide 10mg/6.25mg, Chlorthalidone 25mg and 50mg, Orphenadrine Citrate 100mg ER, Promethazine HCl 6.25mg/5ml syrup, and Trifluoperazine HCl 5mg – these products should be rejected or require manual intervention. (2) UPDATE decreased MAC prices in system for: Erythromycin 250mg ($0.1538), Isosorbide Dinitrate 5mg ($0.0198) and 10mg ($0.0205), Methocarbamol 500mg ($0.1425). (3) UPDATE increased MAC prices for: Carbidopa/Levodopa combinations, Clonidine, Doxycycline, Gemfibrozil, Isosorbide Dinitrate 20mg, Primidone, Trazodone, Triamcinolone, and Verapamil – specific prices listed in policy. (4) ADD new drugs to MAC formulary: Acetaminophen/Butalbital/Caffeine, Acetaminophen/Hydrocodone, Albuterol, Amoxicillin suspension, Hydroxyzine, Metformin, Methocarbamol 750mg, and Propafenone – with their respective MAC prices. Pharmacy staff should verify all price updates are correct in billing software. Contact Pharmaceutical Services at (609) 588-2724 or Unisys at (800) 776-6334 with questions. Claims submitted after March 20, 2004 using old pricing will be denied or subject to adjustment.