MedicaidAdministrativeHigh impact
Newsletter Vol. 12, No. 49
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Jun 1, 2002
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare fee-for-service pharmacy providers must NOT collect co-payments from beneficiaries when other insurance covers the prescription. Instead, providers must bill any outstanding co-payment amounts directly to Unisys (the state fiscal agent) through the point-of-sale system using the appropriate Other Coverage code. This clarifies that co-payments are the state's responsibility, not the beneficiary's.
Action Required
Immediately: Pharmacy billing team must stop collecting co-payment amounts from Medicaid/NJFC FFS beneficiaries. All outstanding co-payments resulting from other insurance coverage must be billed directly to Unisys through the point-of-sale claims processing system using the appropriate Other Coverage code. Providers must update internal procedures and staff training to ensure no co-payments are requested from eligible beneficiaries. This policy does NOT apply to PAAD or Senior Gold Prescription Discount Program beneficiaries—co-payments for those programs must still be collected. Failure to comply will result in improper collections and potential audit findings.