MedicaidPrior AuthMedium impact
Newsletter Vol. 9, No. 70
New Jersey Medicaid·NJ·Prior Authorization
Effective date
Dec 1, 1999
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid requires prior authorization for pharmacy services when beneficiaries exceed 12 prescriptions per month (reducing to 7 over time), effective December 1, 1999. Pharmacists must call First Health Services at 1-877-888-2939 for PA requests when monthly prescription thresholds are exceeded.
Action Required
Before December 1, 1999: Medical billing teams should notify providers that patients receiving multiple prescriptions per month may face pharmacy delays due to new PA requirements. Educate staff that pharmacists will handle PA requests directly with First Health Services (1-877-888-2939), but providers may receive inquiries at 1-877-266-3589. No direct billing system changes required as this primarily affects pharmacy claims processing.