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Newsletter Vol. 13, No. 18

New Jersey Medicaid·NJ · Pharmacy, General Practice, Family Medicine +2 more·Pharmacy
Effective date
Mar 11, 2003
We identified it
Jun 20, 2026
Days to comply

Summary

New Jersey Medicaid updated its Maximum Allowable Cost (MAC) drug pricing effective March 11, 2003. Seven generic drugs had their MAC suspended due to unavailable generic versions. Twenty-three new drugs were added to the MAC list with specific pricing, and pricing was increased for 20 existing drugs while decreased for 6 others. Billing teams must update pharmacy billing systems to reflect these new MAC prices and suspension status.

Action Required

Action needed
By March 11, 2003: Billing and pharmacy teams must update all claims processing systems to implement the following changes: (1) SUSPEND MAC coverage for: Folic Acid 1mg tablets (100ct), Hydralazine HCl 25mg tablets (100ct), Penicillin V Potassium 250mg/5ml (200ml), Prednisone 5mg/10mg/20mg tablets (100ct each), Quinidine Gluconate 324mg extended release (100ct), Theophylline 300mg extended release (100ct), and Triamcinolone Acetonide 0.1% lotion (60ml) and paste (5gm). (2) ADD 23 new MAC-priced drugs to the approved list with their specified MAC prices (see policy for complete pricing table including Albuterol, Ampicillin, Captopril/HCTZ, Glyburide, Lisinopril, Lisinopril/HCTZ, Nizatidine, Tizanidine, and Tramadol). (3) UPDATE pricing for 20 existing drugs with increased MAC prices (Amitriptyline, Benzonatate, Clonidine, Dexamethasone, Furosemide, Gemfibrozil, Hydrochlorothiazide/Propranolol, Hydroxyzine, Imipramine, Metronidazole, Naproxen, Oxazepam, Sulindac, Thioridazine, Thiothixene, Valproic Acid, and Verapamil). (4) UPDATE pricing for 6 drugs with DECREASED MAC prices (Amitriptyline 10mg/25mg, Cefadroxil, Desoximetasone, Hydrocortisone, Methylprednisolone, and Selenium Sulfide). Pharmacy providers and billing staff must immediately update fee schedules in billing software. Claims submitted with old pricing or for suspended drugs will be denied or require manual adjustment. Retain this newsletter for reference.