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Newsletter Vol. 14, No. 04
Act
immediately
Effective date
Jan 1, 2004
Identified
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.
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What to do
immediately · 4 steps
01Pharmacy staff must update prior authorization workflows for Enfuvirtide (requires immediate prior auth for all claims).
02Update 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.
03Monitor for new Error Codes 535, 869/916, and 447 in claim processing system.
04Contact Chief of Pharmaceutical Services at (609) 588-2724 with questions.
Original notice
Newsletter Vol. 14, No. 04
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 14, No. 01MediumEffective Jan 1, 2004 · Prior AuthorizationNewsletter Vol. 14, No. 02HighEffective Jan 21, 2004 · Provider NoticeNewsletter Vol. 14, No. 03LowEffective Dec 11, 2003 · PharmacyNewsletter Vol. 14, No. 05MediumEffective Nov 1, 2003 · CodingBrowse every New Jersey Medicaid change in the policy list