MedicaidPrior AuthMedium impact
Newsletter Vol. 11, No. 35
New Jersey Medicaid·NJ · Pharmacy·Prior Authorization
Effective date
Mar 15, 2001
We identified it
Jun 20, 2026
Summary
Effective March 15, 2001, New Jersey Medicaid programs now require prior authorization for nutritional supplements. However, for beneficiaries under 18 years of age, First Health Services will automatically authorize nutritional supplements when medically necessary, while prior authorization requirements continue for beneficiaries 18 and older. This change applies to Medicaid FFS, NJFC FFS, PAAD, CF, and ADDP pharmacy programs.
Action Required
By March 15, 2001: Pharmacy and billing teams must implement the following changes: (1) For all beneficiaries 18 years and older: Continue requiring prior authorization from First Health Services before dispensing nutritional supplements; update pharmacy system to flag nutritional supplement claims for prior auth review. (2) For beneficiaries under 18 years: Update pharmacy system to submit nutritional supplement claims to First Health Services for automatic authorization when medically necessary—do not delay or deny these claims pending manual review. (3) Ensure all pharmacy staff understand the age-based differentiation to prevent processing errors. (4) Contact First Health Services at (877) 888-2939 or DMAHS at (609) 588-2724 with questions. Claims submitted without proper prior authorization for patients 18+ will be denied; claims for pediatric patients under 18 may be approved by First Health Services without additional provider action if medically necessary.