MedicaidReimbursementMedium impact
Newsletter Vol. 7, No. 15
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Jan 14, 1997
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and related programs (PAAD, GA, ADDP, CFD, GSHP) are suspending the Federal Upper Limit (FUL) pricing for two drugs: Acetazolamide 250 mg tablets and Acebutolol Hydrochloride 200 mg capsules. Effective January 14, 1997, reimbursement for these drugs will be based on the lower of AWP minus 10% plus dispensing fees, or the provider's Usual and Customary Charge, rather than the previous FUL pricing.
Action Required
By January 14, 1997: Billing team must update pharmacy reimbursement logic in billing software to remove FUL-based pricing for Acetazolamide 250 mg tablets (Diamox) and Acebutolol Hydrochloride 200 mg capsules (Sectral). Configure system to calculate reimbursement using the lower of: (1) AWP minus 10% plus applicable dispensing fee, or (2) provider's Usual and Customary Charge. Notify pharmacy providers of the pricing change. Update claim adjudication rules for New Jersey Medicaid, PAAD, GA, ADDP, CFD, and GSHP programs. Failure to implement will result in incorrect reimbursement calculations and potential overpayments or underpayments.