MedicaidReimbursementMedium impact
Newsletter Vol. 9, No. 73
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Oct 22, 1999
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid suspends Federal Upper Limit (FUL) pricing for 8 generic drugs effective October 22, 1999, due to marketplace unavailability. Reimbursement for these drugs will now be based on the lower of AWP minus 10% plus dispensing fee, or the provider's Usual and Customary Charge. This affects erythromycin estolate, folic acid, ibuprofen, lindane, minoxidil, piroxicam, ranitidine hydrochloride, and valproic acid across multiple dosages and package sizes.
Action Required
By October 22, 1999 (or immediately if after this date): Billing team must update pharmacy billing system to remove FUL pricing for the following drugs and apply AWP minus 10% reimbursement methodology instead: erythromycin estolate (250 mg capsule), folic acid (1 mg tablets), ibuprofen (400 mg, 600 mg, 800 mg tablets), lindane (1% lotion and shampoo), minoxidil (2.5 mg and 10 mg tablets), piroxicam (10 mg and 20 mg capsules), ranitidine hydrochloride (150 mg and 300 mg tablets), and valproic acid (250 mg capsules). Update reimbursement calculation rules in billing software to ensure claims are processed at the lower of AWP-10% plus dispensing fee or Usual and Customary Charge. This applies to Medicaid, NJ KidCare, PAAD, GA, and CFD programs. Notify pharmacy staff of the change. Contact Chief of Pharmaceutical Services at (609) 588-2724 with questions.