MedicaidReimbursementLow impact
Newsletter Vol. 7, No. 18
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Feb 11, 1997
We identified it
Jun 20, 2026
Summary
The New Jersey Medicaid program suspended the Federal Upper Limit (FUL) pricing for two pharmaceutical products (Bethanechol Chloride 5mg and Tropicamide 1% Solution) because generic versions are no longer available at FUL prices. 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, effective immediately.
Action Required
By February 11, 1997: Billing team and pharmacy staff must update reimbursement calculations for Bethanechol Chloride 5mg (Urecholine) and Tropicamide 1% Solution (Mydriacyl) claims. Remove FUL-based pricing from billing system and billing reference materials. Apply new reimbursement methodology: calculate the lower of (AWP minus 10% plus dispensing fee) or provider's Usual and Customary Charge for these two drugs only. Update pharmacy billing software and staff training materials. Ensure all claims submitted after the effective date use the new pricing method to avoid payment delays or denials.