MedicaidReimbursementMedium impact
Newsletter Vol. 8, No. 33
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Apr 8, 1998
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid, NJ KidCare, PAAD, GA, and CFD programs are suspending Federal Upper Limit (FUL) pricing for five generic drug products (Lomotil, Combipres, Lasix, Mycostatin, and Aldactone) effective April 8, 1998. 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 previous FUL pricing.
Action Required
Before April 8, 1998: Pharmacy billing team must update reimbursement calculations in billing software for the five affected drug products (Atropine Sulfate/Diphenoxylate Hydrochloride [Lomotil], Chlorthalidone/Clonidine Hydrochloride [Combipres], Furosemide [Lasix], Nystatin [Mycostatin], and Spironolactone [Aldactone]). Remove FUL-based pricing and implement AWP minus 10% plus dispensing fee calculation methodology for all claim submissions to NJ Medicaid, NJ KidCare, PAAD, GA, and CFD programs. Verify that billing system applies the lower of calculated reimbursement or provider's Usual and Customary Charge. Claims submitted under old FUL pricing after the effective date will be subject to recalculation and potential underpayment.