MedicaidReimbursementMedium impact
Newsletter Vol. 13, No. 35
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
May 11, 2003
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is suspending Maximum Allowable Cost (MAC) pricing for 5 generic drugs due to marketplace unavailability, and updating Federal Upper Limits (FUL) pricing for 13 additional medications effective May 11, 2003. Billing teams must update MAC price tables in their systems and remove suspended drugs from MAC-based reimbursement calculations to avoid claim denials.
Action Required
By May 11, 2003: Billing team must update pharmacy claim processing system to reflect new MAC prices listed in the policy. SUSPENDED DRUGS (remove from MAC pricing): Acetylcysteine 20% inhalation/oral, Desoximetasone 0.25% cream, Diflunisal 500mg tablet, Theophylline 100mg and 200mg extended-release tablets. PRICE INCREASES (update in system): Alprazolam (0.25mg-2mg), Amiloride/HCTZ, Amitriptyline, Ampicillin, Benzonatate, Bumetanide, Cholestyramine, Cyclobenzaprine, Minocycline, Temazepam, Tolazamide, and Verapamil with new rates specified. PRICE CHANGES (update in system): Amiodarone, Hydroxyzine Pamoate, Labetalol, and Methocarbamol with revised rates. Verify pharmacy billing software applies suspended drugs at actual acquisition cost rather than MAC. Notify pharmacy providers of price changes. Failure to update pricing will result in claim overpayments or denials for reimbursement at incorrect rates.