MedicaidReimbursementHigh impact
Newsletter Vol. 11, No. 01
New Jersey Medicaid·NJ · Pharmacy·Reimbursement
Effective date
Dec 7, 2000
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid updated its Maximum Allowable Cost (MAC) drug payment limits effective December 7, 2000. Providers must replace the October 1998 MAC drug list (Appendix B) with the revised December 7, 2000 list in their Pharmaceutical Services Manual. This affects reimbursement limits for covered generic and multi-source drugs across Medicaid FFS, NJ KidCare FFS, GA, ADDP, CF, and PAAD programs.
Action Required
By December 7, 2000 (retroactive): Pharmacy providers and HMOs must immediately discard the MAC drug list (Rev. 10/98) from Newsletter Volume 8, No. 71 and replace it with the new MAC Drug List (Rev. 12/7/2000) as APPENDIX B in the Pharmaceutical Services Manual. Update all billing systems, pharmacy software, and claim processing workflows to apply the revised Federal upper limits to all claims with service dates on or after December 7, 2000. Verify the updated list on the HCFA website at www.hcfa.gov/medicaid/drug10.htm. Note that brand names listed are for reference only—all equivalent generic/multi-source products are subject to the same MAC limits. For questions, contact DMAHS Chief of Pharmaceutical Services at (609) 588-2724 or Unisys Pharmacy Consultant at (609) 588-6039. Failure to apply updated MAC limits will result in claim denials and payment adjustments.