MedicaidReimbursementHigh impact
Newsletter Vol. 13, No. 60
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Aug 24, 2003
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is updating Maximum Allowable Cost (MAC) drug pricing effective August 24, 2003. Five generic drugs have suspended MAC coverage due to unavailable generic versions, while pricing for 13 other drugs has increased and 9 drugs have decreased. Three new drugs have been added to the MAC list with established pricing. Billing teams must update pharmacy claims processing to reflect these new MAC prices and suspension status.
Action Required
By August 24, 2003: Billing and pharmacy teams must update Medicaid claims processing system with new MAC pricing and suspensions. SPECIFIC ACTIONS: (1) Remove MAC coverage for Dexamethasone 0.5mg/5ml elixir (240ml), Lovastatin 40mg tablet (60ct), Naproxen 375mg delayed-release tablet (100ct), and both Trifluoperazine HCl strengths (1mg, 2mg, 10mg) - these drugs are no longer reimbursable under MAC program; (2) Update system to reflect price INCREASES for Flurazepam HCl (Dalmane), Hydroxyzine HCl (Atarax), Medroxyprogesterone Acetate (Provera), Nifedipine (Procardia), Perphenazine (Trilafon), and Valproic Acid (Depakene) per pricing listed in policy; (3) Update system to reflect price DECREASES for Acyclovir (Retrovir), Imipramine HCl (Tofranil), Pindolol (Visken), Sulfasalazine (Azulfidine), Thioridazine HCl (Mellaril), and Trihexyphenidyl HCl per pricing listed in policy; (4) Add three new drugs to MAC coverage: Desonide 0.05% cream (DesOwen), Enalapril Maleate (Vasotec) at four strength levels, and Ipratropium Bromide (Atrovent); (5) Configure system to reject or downcode claims for suspended drugs and apply correct MAC prices to all affected medications. Contact New Jersey DMAHS at (609) 588-2724 for clarification. Failure to implement changes will result in claims being denied or improperly reimbursed.