MedicaidReimbursementHigh impact
Newsletter Vol. 5, No. 38
New Jersey Medicaid·NJ · Pharmacy·Reimbursement
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
This policy updates the Maximum Allowable Cost (MAC) drug list for Medicaid reimbursement, effective July. Providers must replace the previous MAC drug list (Appendix B Rev) with the newly published revision and apply the updated federal upper payment limits to pharmaceutical claims. Some products may require prior authorization or may not be covered by Medicaid or PAAD programs.
Action Required
By July 2024: Billing team and pharmacy staff must obtain and implement the updated MAC Drug List (Appendix B Rev) published by HCFA. Actions required: (1) Discard the previous MAC drug list (Appendix B Rev from Newsletter Volume No [prior version]) from the Pharmaceutical Services Manual; (2) Insert the new MAC Drug List (Appendix B Rev) into the Pharmaceutical Services Manual; (3) Update billing system pharmacy claim edits to reflect new MAC pricing limits for all pharmaceutical codes; (4) Train pharmacy billing staff on any new products added, removed, or reclassified; (5) Verify that prior authorization workflows are configured for products requiring prior auth per Division policy. Consequence of inaction: Claims submitted using outdated MAC limits may be underpaid or denied, and non-covered products may be rejected. Contact New Jersey Medicaid Chief Pharmaceutical Services or local District Office with questions. Retain this newsletter numerically behind the newsletter tab marked with blue tab.