MedicaidReimbursementHigh impact
Newsletter Vol. 10, No. 51
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Jul 1, 2000
We identified it
Jun 20, 2026
Summary
New Jersey is updating Average Wholesale Price (AWP) calculations for certain prescription drugs effective July 1, 2000, based on First Data Bank's revised market-based pricing methodology. Reimbursement for Medicaid, GA, PAAD, ADDP, and CF pharmacy claims will now be based on the lower of the pharmacy's usual and customary charge or AWP plus a dispensing fee of $3.73–$4.07, with MAC pricing continuing to apply where appropriate.
Action Required
By July 1, 2000: Pharmacy providers in New Jersey must update billing systems to apply the new AWP calculations based on First Data Bank's revised pricing data. Billing team must reprogram reimbursement formulas to calculate claims as the lower of (1) pharmacy's usual and customary charge or (2) revised AWP plus dispensing fee of $3.73–$4.07. Verify that Maximum Allowable Cost (MAC) pricing logic continues to apply appropriately. Cross-reference the attached drug list (Appendix B) to identify affected medications and update pricing tables accordingly. Failure to implement these changes will result in claim rejections or incorrect reimbursement for affected Medicaid, GA, PAAD, ADDP, and CF pharmacy claims.