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All PlansPrior AuthMedium impact

Newsletter Vol. 6, No. 10

New Jersey Medicaid·NJ·Prior Authorization
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

A new Real-Time Point-Of-Sale (POS) and Prospective Drug Utilization Review (PDUR) claims processing system is being implemented for prescription drug coverage. This system will provide immediate electronic authorization and utilization review at the time prescriptions are filled at the pharmacy.

Action Required

Action needed
Monitor for implementation timeline and any required system updates. Inform providers that prescription drug authorizations and utilization reviews will now be processed in real-time at pharmacies. No immediate billing system changes required, but be prepared for potential changes to prescription-related prior authorization workflows.

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