MedicaidPrior AuthHigh impact
Newsletter Vol. 13, No. 64
New Jersey Medicaid·NJ · Pharmacy, Family Medicine, Internal Medicine +4 more·Provider Notice
Effective date
Oct 1, 2003
We identified it
Jun 20, 2026
Summary
New Jersey mandates prior authorization for brand-name multi-source drugs when generic alternatives exist for Medicaid, NJ FamilyCare, PAAD, Senior Gold, and ADDP beneficiaries. Effective October 1, 2003, prescribers must obtain an authorization number from DMAHS or DHSS before dispensing brand drugs; pharmacies may only dispense a 10-day supply without authorization.
Action Required
By October 1, 2003: Prescribers and clinical staff must implement prior authorization workflow for all brand-name multi-source drug prescriptions for eligible beneficiaries. Providers must obtain authorization number from NJ DMAHS or DHSS before prescribing and include the authorization number on each prescription. Update prescription templates and provider communication materials to require authorization numbers. Billing team must verify authorization numbers are present on pharmacy claims; claims without authorization numbers will result in pharmacies dispensing only 10-day supplies pending authorization. Contact Office of Utilization Management at (609) 588-2718 with questions. Display the attached poster at place of business to inform beneficiaries of the policy change.