MedicaidReimbursementLow impact
Newsletter Vol. 6, No. 52
New Jersey Medicaid·NJ · OB-GYN, Internal Medicine, Family Medicine +1 more·Pharmacy
Effective date
Aug 1, 1996
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has suspended Federal Upper Limit pricing for Triple Sulfa vaginal cream and Clofibrate capsules due to generic unavailability. Reimbursement will now be based on Average Wholesale Price minus 10% or usual and customary charges, whichever is lower.
Action Required
Immediately: Billing team should note this is an outdated 1996 policy that should not be implemented. Verify current reimbursement rates for Triple Sulfa vaginal cream and Clofibrate with New Jersey Medicaid program. Contact Medicaid at (609) 588-2724 for current pricing information if these medications are prescribed.