MedicaidCoverageMedium impact
Newsletter Vol. 10, No. 38
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
May 1, 2000
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is exempting six drug classes from the Monthly Prescription Volume Threshold Process (MPTP) effective immediately. Prescriptions for oral contraceptives, ophthalmic preparations, otic preparations, nitroglycerin patches, vaginal preparations, and hemorrhoidal preparations will no longer count toward monthly prescription limits and will not trigger error codes 413-416.
Action Required
Immediately: Pharmacy billing staff must update claim submission protocols to exclude the six exempted drug classes from MPTP calculations. Configure billing system to NOT apply error codes 413-416 to prescriptions for: oral contraceptives, ophthalmic preparations, otic preparations, nitroglycerin patches, vaginal preparations, and hemorrhoidal preparations. Contact First Health Services at 1-877-888-2939 or DMAHS Pharmaceutical Services at (609) 588-2724 if system configuration questions arise. Failure to apply these exemptions may result in incorrect claim rejections or manual intervention requirements.