MedicaidReimbursementMedium impact
Newsletter Vol. 9, No. 30
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Apr 21, 1999
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid suspends Federal Upper Limit (FUL) pricing for three drug products (Darvocet N-100, Vasocidin ophthalmic solutions in two strengths) effective April 21, 1999. 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, instead of the suspended FUL.
Action Required
By May 1999 (or immediately if current date is after April 21, 1999): Pharmacy billing team must update billing system reimbursement rules for the three affected drug products: Acetaminophen/Propoxyphene Napsylate (Darvocet N-100), and Prednisolone Sodium Phosphate/Sulfacetamide Sodium (Vasocidin) in both 5ml and 10ml ophthalmic solutions. Remove FUL-based pricing and replace with AWP minus 10% discount plus applicable dispensing fee calculation, or Usual and Customary Charge (whichever is lower). Update claim adjudication logic in billing software to reflect new reimbursement methodology for NJ Medicaid, NJ KidCare, PAAD, GA, and CFD programs. Verify changes with pharmacy consultant at (609) 588-6039 to avoid claim denials or underpayment.