MedicaidPrior AuthMedium impact
Newsletter Vol. 11, No. 79
New Jersey Medicaid·NJ · Pharmacy, Family Medicine, Internal Medicine +1 more·Provider Notice
Effective date
Oct 15, 2001
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is implementing a severe drug-drug interaction alert (Error Code 869) for concurrent use of Advair Diskus with Serevent or Flovent. Initial 30-day supplies may be dispensed, but subsequent refills require prior authorization from First Health Clinical Services. Pharmacists must intervene when inappropriate combinations are identified.
Action Required
By October 15, 2001: Billing and pharmacy teams must implement the following: (1) Recognize Error Code 869 in billing system for overlapping Advair/Serevent or Advair/Flovent claims; (2) Allow initial 30-day supply to process without prior authorization under Medical Exception Process (MEP); (3) For subsequent refills, require pharmacists to contact First Health Clinical Services at 1-877-888-2939 for prior authorization before dispensing; (4) Educate providers and pharmacists that Advair + Serevent combination is inappropriate and requires intervention, while Advair + Flovent may be warranted temporarily during dose titration; (5) Ensure pharmacists perform prospective drug review per OBRA 1990 requirements and counsel patients on interactions. Failure to obtain prior authorization for subsequent supplies will result in claim denials. Refer to Newsletter Vol. 9 No. 67 for Medical Exception Process procedures.