MedicaidReimbursementMedium impact
Newsletter Vol. 11, No. 08
New Jersey Medicaid·NJ · Pharmacy, Pulmonology, Pediatrics·Pharmacy
Effective date
Dec 8, 2000
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and related programs are suspending the Maximum Allowable Cost (MAC) pricing for Albuterol (Proventil) 0.09 mg/inhalation aerosol due to lack of generic availability at federal upper limits. Effective December 8, 2000, reimbursement for this drug will be based on Average Wholesale Price minus 10% plus dispensing fees, or the provider's usual and customary charge, whichever is lower.
Action Required
By January 2001: Billing team must update reimbursement calculations for Albuterol (Proventil) 0.09 mg/inhalation aerosol in billing system. Remove MAC pricing and implement AWP-minus-10% calculation methodology for all NJ Medicaid, NJ FamilyCare, PAAD, General Assistance, and Cystic Fibrosis Drug program claims. Verify billing software applies the lower of (AWP - 10% + dispensing fee) or usual and customary charge. Contact Pharmaceutical Services at (609) 588-2724 if system requires modifications. Failure to implement correct pricing will result in claim denials or overpayment recoveries.