MedicaidCoverageHigh impact
Newsletter Vol. 9, No. 64
New Jersey Medicaid·NJ · Pharmacy·Medical Policy
Effective date
Jan 1, 2000
We identified it
Jun 20, 2026
Summary
Effective January 1, 2000, GA (General Assistance) beneficiaries diagnosed with HIV/AIDS must enroll in the AIDS Drug Distribution Program (ADDP) administered by the New Jersey Department of Health and Senior Services. GA will discontinue direct coverage and reimbursement for HIV/AIDS-specific drugs; all such medications will be covered exclusively through ADDP. Pharmacies must verify ADDP eligibility and exhaust ADDP coverage before submitting claims to GA, with denied claims marked by Edit 402.
Action Required
By December 31, 1999: (1) Billing and pharmacy teams must update systems to require ADDP eligibility verification for all GA beneficiaries with HIV/AIDS diagnoses before processing pharmaceutical claims. (2) Configure billing software to route HIV/AIDS drug claims to ADDP first and deny GA claims with Edit 402 ("Not covered by GA; bill ADDP") for drugs on the ADDP Formulary. (3) Establish workflow to collect and validate ADDP identification numbers from patients and ensure pharmacy selection notification is received from ADDP before billing. (4) Train all billing and pharmacy staff on the new process: exhaust ADDP coverage before submitting to GA. (5) Ensure all staff handling patient information maintain strict confidentiality of HIV/AIDS diagnoses per N.J.S.A. 26:5C-5 et seq. Failure to route claims through ADDP first will result in GA claim denials and loss of reimbursement.