MedicaidReimbursementMedium impact
Newsletter Vol. 11, No. 01
New Jersey Medicaid·NJ·Reimbursement
We identified it
Jun 20, 2026
Summary
Federal Upper Limits of Payment for Maximum Allowable Cost (MAC) drugs have been revised in Appendix B. This affects reimbursement rates for generic prescription drugs covered under medical benefits, requiring billing teams to update their fee schedules and payment expectations.
Action Required
Immediately: Billing team must download the updated Appendix B from the source document to review revised MAC drug pricing limits. Update billing system fee schedules for affected generic drugs to reflect new federal upper payment limits. Verify contracted rates against new MAC limits to ensure proper reimbursement expectations.