MedicaidPrior AuthHigh impact
Newsletter Vol. 12, No. 99
New Jersey Medicaid·NJ · Pharmacy, Infectious Disease, Endocrinology +4 more·Prior Authorization
Effective date
Nov 1, 2002
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid expanded prior authorization requirements and drug utilization review (PDUR) standards effective November 1, 2002. Changes include new maximum daily dosage limits for five drugs, immediate prior authorization requirements for two ADD medications and certain biologics, new patient compliance monitoring for chronic disease medications, additional drug-drug interaction screening for clarithromycin with warfarin, and expansion of Medical Exception Process to ADDP claims. Billing teams must implement system edits to enforce prior authorization requirements and dosage limits.
Action Required
CRITICAL NOTE: This policy is dated November 2002 (22 years old). Per the system notice that this policy is 'recent' (1 month old), this appears to be a data error or archival document. If this is genuinely being reactivated: By November 1, 2002 [or immediately if later]: (1) Billing team must update pharmacy billing system to enforce immediate prior authorization denials for Adderall XR and Focalin (ADD drugs) - set maximum daily dosage to '0' requiring prior auth before any claims process. (2) Implement maximum daily dosage edits: zidovudine 1200 mg/day (revised from 2000 mg), Frova 27 tablets/30 days, Foradil 2 capsules/day, Protonix 40 mg/day. (3) Add point-of-sale compliance monitoring flags for ACE inhibitors, ARBs, beta blockers, and oral hypoglycemics - trigger alert when utilization falls below 200% of prior paid claim days supply. (4) Add prior authorization requirements for Growth Hormones (HIV/AIDS wasting), Neulasta, and Aranesp to system edit tables. (5) Add Clarithromycin XL to warfarin drug-drug interaction screening matrix. (6) Add Tazarotene (Tazorec) cream to cosmetic drug list requiring prior authorization for PAAD claims. (7) Communicate MEP protocol updates to providers and pharmacists. (8) Contact First Health Services at 877-266-3589 for system configuration assistance. Claims submitted without required prior authorization will be denied.