MedicaidPrior AuthMedium impact
Newsletter Vol. 13, No. 42
New Jersey Medicaid·NJ · Family Medicine, Internal Medicine, General Practice +6 more·Prior Authorization
Effective date
Apr 1, 2003
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid updated drug utilization review standards adding maximum daily dosage limits for 12 medications (including some requiring immediate prior authorization), new drug interaction warnings, therapeutic duplication monitoring for SSRIs, and gender restrictions for Zelnorm. These changes affect pharmacy claims processing and prior authorization requirements.
Action Required
Immediately: Billing team must update pharmacy claims processing system to reflect new PDUR standards for New Jersey Medicaid patients. Configure maximum daily dosage limits for ezetimibe, aripiprazole, and carisoprodol. Set immediate prior authorization requirements for buprenorphine, tazarotene, and modafinil (dosage limit = 0). Update drug interaction checks for combination medications like Avandamet, Glucovance, and Foradil. Restrict Zelnorm prescriptions to female patients only. Review Medical Exception Process procedures for override requests.