MedicaidReimbursementMedium impact
Newsletter Vol. 13, No. 19
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Apr 7, 2003
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid suspends Maximum Allowable Cost (MAC) pricing for three acetylcysteine and glyburide formulations effective April 7, 2003, due to unavailable generic versions. Additionally, Federal Upper Limits (FUL) price increases apply to gemfibrozil and hydroxyzine pamoate, affecting reimbursement rates for these medications.
Action Required
By April 7, 2003: Billing team must update pharmacy billing system to remove MAC pricing for acetylcysteine 10% solution (10 mL inhalation/oral), glyburide 1.25 mg (100-count tablet), glyburide 2.5 mg (100-count tablet), and glyburide 5 mg (100-count tablet). Update pricing tables to reflect new FUL rates: gemfibrozil 600 mg (500-count) at $0.3058 per unit and hydroxyzine pamoate 50 mg equivalent (100-count) at $0.1178 per unit. Verify that suspended drugs route through alternative reimbursement methodology (likely standard Medicaid rates). Contact Unisys Provider Services at (800) 776-6334 or NJ DMAHS at (609) 588-2724 with questions. Failure to update pricing will result in incorrect claim submissions and denials.