MedicaidReimbursementMedium impact
Newsletter Vol. 13, No. 68
New Jersey Medicaid·NJ·Pharmacy
We identified it
Jun 20, 2026
Summary
New Medicaid Drug Federal Upper Limits of Payment for Maximum Allowable Cost (MAC) Drugs have been updated in Appendix B. This affects reimbursement rates for specific medications covered under Medicaid pharmacy benefits.
Action Required
Immediately: Billing and pharmacy teams should review the updated MAC drug list in Appendix B at https://www.njmmis.com/documentDownload.aspx?document=13-68.pdf to understand new reimbursement limits for Medicaid prescription claims. Update billing systems with new maximum allowable cost amounts for affected medications.