MedicaidReimbursementMedium impact
Newsletter Vol. 12, No. 66
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Aug 1, 2002
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is suspending Maximum Allowable Cost (MAC) pricing for 8 generic drugs effective August 1, 2002, and updating MAC prices for 5 additional drugs. Billing teams must stop applying MAC limits to suspended drugs and update reimbursement rates for drugs with new pricing to avoid claim denials and payment discrepancies.
Action Required
REQUIREMENTS:
- By August 1, 2002: Billing team must update pharmacy billing system to remove MAC price limits for the following suspended drugs: Ampicillin/Ampicillin Trihydrate (250mg and 500mg capsules), Codeine Phosphate/Promethazine HCl syrup, Desipramine HCl (all strengths), Hydroxyurea 500mg, Hydroxyzine HCl (all strengths), and Methocarbamol 750mg.
- By August 1, 2002: Pharmacy or billing staff must update MAC prices in the system for: Allopurinol 300mg ($0.1671), Amantadine HCl 100mg ($0.2463), Amitriptyline HCl 10mg ($0.0891) and 25mg ($0.0936), Bumetanide 1mg ($0.2348) and 2mg ($0.4272).
- Providers submitting New Jersey Medicaid pharmacy claims must verify drug and dosage against the updated list before billing.
- Failure to update pricing will result in claim denials or incorrect reimbursement.