All PlansPrior AuthMedium impact
Newsletter Vol. 7, No. 29
New Jersey Medicaid·NJ·Prior Authorization
We identified it
Jun 20, 2026
Summary
New brand authorization requirements have been implemented for Maximum Allowable Cost (MAC) prescriptions. When generic drugs reach their MAC pricing limit, additional authorization will be required for brand-name alternatives.
Action Required
Immediately: Review current MAC prescription protocols and update prior authorization workflows for brand-name drugs when generics hit MAC limits. Coordinate with pharmacy staff to identify MAC-affected medications. Notify providers that additional documentation may be required for brand authorizations.