MedicaidReimbursementMedium impact
Newsletter Vol. 10, No. 20
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Jan 15, 2000
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid, NJ KidCare, PAAD, GA, and CFD programs are suspending Federal Upper Limit (FUL) pricing for seven generic drug products effective January 15, 2000. Reimbursement will now be based on the lower of AWP minus 10% plus dispensing fee, or the provider's Usual and Customary Charge. Affected drugs include Vicodin, Velosef, Periactin, Norpace, Esidrix/Hydrodiuril, and Tolectin.
Action Required
By January 15, 2000: Billing team must update pharmacy billing software to remove Federal Upper Limit pricing for the seven suspended drug products (Acetaminophen/Hydrocodone Bitartrate, Cephradine, Cyproheptadine Hydrochloride, Disopyramide Phosphate, Hydrochlorothiazide, and Tolmetin Sodium). Configure system to calculate reimbursement using the lower of: (1) Average Wholesale Price minus 10% discount plus applicable dispensing fee, or (2) provider's Usual and Customary Charge. Update pharmacy claim submission rules in all billing systems handling New Jersey Medicaid, NJ KidCare, PAAD, GA, or CFD claims. Failure to implement these changes will result in claim denials or improper reimbursement. Retain this newsletter in the pharmacy policy file for reference.