MedicaidReimbursementMedium impact
Newsletter Vol. 11, No. 67
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Jun 13, 2001
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid suspends Maximum Allowable Cost (MAC) pricing for three drug products (Haloperidol, Prednisolone Sodium Phosphate, and Theophylline 450mg) effective June 13, 2001, requiring reimbursement based on AWP minus 10% plus dispensing fees instead. Additionally, MAC prices are updated for 10 other medications with new reimbursement limits that must be reflected in billing systems.
Action Required
By August 2001 (publication date): Billing team must immediately update pharmacy claim processing system to reflect MAC price suspensions for Haloperidol (all strengths), Prednisolone Sodium Phosphate ophthalmic drops, and Theophylline 450mg extended release tablets. Configure system to reimburse these three drugs using AWP minus 10% calculation plus applicable dispensing fees instead of MAC pricing. Additionally, update system with new MAC prices for remaining 10 drugs listed (Acetaminophen/Codeine combinations, Acetaminophen/Hydrocodone, Amitriptyline, Diflunisal, Dipyridamole, Gramicidin/Neomycin/Polymyxin B, Metoclopramide, Prazosin, Theophylline 200mg/300mg, and Verapamil) with specific dollar limits provided. Verify pharmacy billing software accurately reflects all price changes before processing claims with service dates on or after June 13, 2001. Failure to implement changes will result in incorrect reimbursement amounts and claim denials for affected medications.