MedicaidAdministrativeLow impact
Newsletter Vol. 12, No. 109
New Jersey Medicaid·NJ · Family Medicine, Internal Medicine, Pulmonology +2 more·Prior Authorization
Effective date
Oct 1, 2002
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has implemented changes to their Prospective Drug Utilization Review (PDUR) program, adding under-utilization monitoring for Advair inhalants and new maximum daily dosage limits for calcium channel blockers in patients 65+. Pharmacies will receive error codes when these limits are exceeded.
Action Required
No immediate action required for billing teams. This policy affects pharmacy claims processing through point-of-sale systems and does not impact physician billing or coding practices. Pharmacists will receive automated error codes for under-utilization and dosage concerns.