MedicaidAdministrativeHigh impact
Newsletter Vol. 10, No. 24
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Apr 1, 2000
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has amended its Monthly Prescription Volume Threshold (MPTP) Process effective immediately. Key changes include: (1) exempting all non-legend (over-the-counter) drugs from the threshold, (2) exempting all lock-in beneficiaries, and (3) implementing a staggered start date system based on the 10th digit of beneficiary ID numbers. Effective April 1, 2000, the MPTP threshold value is set to 12 prescriptions per calendar month.
Action Required
Immediately: Pharmacy billing staff must update claim submission processes to implement the new MPTP staggering system. Effective immediately, stop applying MPTP limits to: (1) all non-legend/OTC drugs, and (2) all lock-in beneficiaries. Update pharmacy software to calculate MPTP start dates using the 10th digit of beneficiary ID numbers (0-3=1st day, 4-6=10th day, 7-9=20th day of calendar month). By April 1, 2000: Configure system to enforce the MPTP threshold of 12 prescriptions per month for affected beneficiaries. Train pharmacy billing team on exemption categories and staggered counting methodology. Verify with First Health Services (1-877-888-2939) if technical support is needed for system updates. Retain this newsletter for reference in pharmacy billing procedures.