MedicaidPrior AuthHigh impact
Newsletter Vol. 13, No. 49
New Jersey Medicaid·NJ · Pharmacy, Dentistry, Optometry +1 more·Provider Notice
Effective date
Jul 8, 2003
We identified it
Jun 20, 2026
Summary
New Jersey implemented mandatory prior authorization for brand-name multi-source drugs across five state programs (WFNJ/GA, NJ FamilyCare/Medicaid, PAAD, Senior Gold, ADDP) effective July 8, 2003. Pharmacists must obtain prior authorization numbers from First Health Services before dispensing brand-name drugs, with a grace period through August 31, 2003 where claims post informational messages only. After September 1, 2003, claims for brand-name drugs without prior authorization will be denied.
Action Required
By September 1, 2003: (1) Billing team must update pharmacy claim submission system to require prior authorization number entry for all brand-name multi-source drug claims. (2) Providers and pharmacists must contact First Health Services at 1-877-888-2939 (Mon 7AM-7PM, Tue-Fri 8AM-7PM, Sat 9AM-1PM) BEFORE dispensing brand-name drugs to request prior authorization. (3) Pharmacists must document the prior authorization number on prescriptions and include it in claim submissions, or claims will be denied with Error Code 417. (4) Providers should note 10-day supply exception allows initial brand-name dispensing without prior auth to facilitate authorization discussion. (5) Verify prescriptions for exempt drug categories (Atypical Antipsychotics, AIDS/HIV drugs, Anticonvulsants, Digoxin, Warfarin, Cyclosporin, Levothyroxine, Theophylline, Lithium Carbonate, Hormone Replacement Therapy) which do NOT require prior authorization. July 8-August 31, 2003: Monitor for Error Code 417 informational messages as grace period; contact prescribers proactively per First Health instructions.