MedicaidReimbursementMedium impact
Newsletter Vol. 9, No. 40
New Jersey Medicaid·NJ · Pharmacy, Pediatrics, General Practice·Provider Notice
Effective date
Jul 1, 1999
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid, General Assistance, and NJ KidCare programs now require pharmacists to dispense the least expensive generic protein nutritional supplements and specialized infant formulas unless the prescriber handwrites 'Brand Medically Necessary' on the prescription. Pharmacists must also mark 'Medical Certification' on the claim when a brand override is requested.
Action Required
By July 1, 1999 (or immediately if after this date): 1) Physicians: Update prescription writing practices to handwrite 'Brand Medically Necessary' on each prescription or follow-up written prescription when brand-name protein nutritional supplements or specialized infant formulas are medically required. 2) Pharmacy/Billing Team: Ensure pharmacists understand the new dispensing requirement—default to least expensive therapeutically equivalent product unless 'Brand Medically Necessary' is documented by prescriber. Mark 'Medical Certification' on pharmacy claims when brand override is present. 3) Billing System: Configure to reflect brand vs. generic reimbursement differences for these product categories. Note: Prescriber override capability under N.J.S.A. 24:6E-1 et seq. does not apply to this policy. Claims lacking proper documentation will be subject to generic substitution reimbursement rates.