MedicaidReimbursementMedium impact
Newsletter Vol. 11, No. 42
New Jersey Medicaid·NJ·Pharmacy
Effective date
Apr 2, 2001
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has suspended Maximum Allowable Cost (MAC) pricing for several drugs including Keflex, Haldol, Pen-Vee K, and others, switching to AWP minus 10% reimbursement. MAC prices for other drugs like Tylenol with Codeine and Sinemet have been updated with new specific pricing.
Action Required
Immediately: Pharmacy billing staff must update reimbursement calculations for suspended MAC drugs (Cephalexin, Haloperidol, Penicillin V Potassium, Procainamide, Trimethoprim) to use AWP minus 10% plus dispensing fee instead of MAC pricing. Update billing system with new MAC prices for Acetaminophen/Codeine, Carbidopa/Levodopa, and other listed medications. Retain this newsletter behind blue tab 5 for reference.