MedicaidPrior AuthMedium impact
Newsletter Vol. 14, No. 04
New Jersey Medicaid·NJ · Infectious Disease, Pain Management·Prior Authorization
Effective date
Jan 1, 2004
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and related programs have updated their drug utilization review standards effective January 1, 2004. Changes include new prior authorization requirements for Enfuvirtide, additional drug-drug interaction monitoring for HIV medications and methadone combinations, and new cumulative dosage limits for combination drugs containing acetaminophen.
Action Required
Immediately: Pharmacy staff must update prior authorization workflows for Enfuvirtide (requires immediate prior auth for all claims). Update drug interaction screening systems to flag new contraindicated combinations including HIV medications (Retrovir, Combivir, Trizivir, Epivir, Ziagen, Kaletra, Norvir, Zerit, Hivid, Videx) and methadone with Subutex. Monitor for new Error Codes 535, 869/916, and 447 in claim processing system. Contact Chief of Pharmaceutical Services at (609) 588-2724 with questions.