MedicaidCoverageMedium impact
Newsletter Vol. 11, No. 84
New Jersey Medicaid·NJ · Pharmacy, Family Medicine, Internal Medicine +1 more·Provider Notice
Effective date
Nov 15, 2001
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid implemented enhanced Prospective Drug Utilization Review (PDUR) standards effective November 15, 2001, adding maximum daily dosage limits for three Advair formulations and Butorphenol NS (all capped at 1 canister/month and 4 vials/month respectively), and requiring First Health Services to conduct retrospective reviews of oral glucocorticoid claims exceeding 90 days of therapy with prescriber outreach for bone density monitoring.
Action Required
By November 15, 2001: (1) Billing and pharmacy teams must update claim processing systems to enforce new maximum daily dosage standards for Advair 100/50, 250/50, 500/50 (1 canister/month all ages) and Butorphenol NS (4 vials/month all ages)—claims exceeding limits will be flagged with Error Code 535 and require pharmacy consultation. (2) Pharmacy staff must be aware that First Health Services will automatically conduct retrospective reviews of Medicaid FFS and PAAD pharmacy claims for oral glucocorticoids exceeding 90 days; Error Code 880 will post to affected claims to indicate this review process. (3) Providers should expect outreach letters from First Health Services regarding long-term glucocorticoid therapy encouraging bone mineral density monitoring evaluation. For questions, contact DMAHS Chief Pharmaceutical Consultant at (609) 588-2724 or First Health Services at (877) 266-3589.