MedicaidCoverageHigh impact
Newsletter Vol. 9, No. 39
New Jersey Medicaid·NJ · Pharmacy·Eligibility
Effective date
Jul 1, 1999
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid, General Assistance, and NJ KidCare Plan A Fee-For-Service programs are changing pharmacy days supply limits effective July 1, 1999. Initial prescriptions are limited to 34-day supply; refill prescriptions are limited to 34-day supply or 100 dosage units, whichever is greater. This replaces the previous uniform 34-day limit and aligns with PAAD program requirements.
Action Required
By June 30, 1999: Billing and pharmacy teams must implement new days supply validation logic in pharmacy claims processing systems. (1) Update pharmacy management software to differentiate between 'Initial Prescription Claims' (no claim for same drug in prior 200 days OR gap exceeds 2x previous days supply) and 'Refill Prescription Claims' (within 2x previous days supply). (2) Configure system to enforce 34-day maximum for all Initial Prescription Claims. (3) Configure system to enforce 34-day OR 100 dosage units (whichever is greater) for all Refill Prescription Claims. (4) Update Point-of-Sale (POS) system monitoring to track these limitations automatically where available. (5) If POS monitoring is unavailable, ensure pharmacists manually verify days supply limits do not exceed policy requirements for same pharmacy + same beneficiary combinations. (6) Train pharmacy staff and billing team on new definitions and claim categorization logic. (7) Post beneficiary notice (provided in policy) in pharmacy locations. Failure to implement these controls will result in claim denials for prescriptions exceeding the new days supply limitations.