MedicaidReimbursementMedium impact
Newsletter Vol. 12, No. 08
New Jersey Medicaid·NJ·Reimbursement
We identified it
Jun 20, 2026
Summary
Federal Upper Limits of Payment for Maximum Allowable Cost (MAC) drugs have been revised, affecting reimbursement rates for generic medications. This update likely changes the maximum payment amounts that will be reimbursed for covered generic drugs under government programs.
Action Required
Immediately: Billing team must review the revised MAC drug list in Appendix B at https://www.njmmis.com/documentDownload.aspx?document=12-08.pdf to identify any generic medications commonly prescribed in your practice. Update billing system with new maximum reimbursement amounts for affected drugs. Verify current drug pricing to ensure claims are submitted at or below the new MAC limits to avoid payment reductions.