MedicaidCoverageMedium impact
Newsletter Vol. 8, No. 48
New Jersey Medicaid·NJ · Urology, Family Medicine, Internal Medicine·Medical Policy
Effective date
Jul 1, 1998
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid, GA, and PAAD programs are limiting coverage of impotency drugs (Viagra, Caverject, Muse) to males over 18 years with a maximum of 4 treatments per 30-day period. Starting August 1, 1998, prescribers must write 'Diagnosis of Impotence' on the prescription face or claims will be subject to recoupment.
Action Required
By August 1, 1998: Providers must write 'Diagnosis of Impotence' on the face of all prescriptions for impotency drugs (Viagra, Caverject, Muse). Billing team must verify this documentation is present before submitting claims to NJ Medicaid, GA, and PAAD. Claims without this notation will be subject to state recoupment. Also verify patient eligibility (male, over 18) and ensure quantity limits are not exceeded (4 treatments per 30 days).