MedicaidReimbursementHigh impact
Newsletter Vol. 5, No. 24
New Jersey Medicaid·NJ · Pharmacy·Pharmacy
Effective date
Feb 21, 1995
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and related programs (PAAD, GA, CFD, ADDP) are eliminating the $24.99 claim amount ceiling for pharmacy reimbursement regression calculations. Effective February 21, 1995, ALL pharmacy claims regardless of amount will be subject to a 0-6% regression calculation based on pharmacy volume. Additionally, the $0.05 per-claim EMC incentive program is being discontinued.
Action Required
By February 21, 1995: Billing team must update pharmacy billing system to apply regression calculations to ALL claims (not just those under $24.99) for Medicaid, PAAD, GA, CFD, and ADDP programs. Remove the $24.99 ceiling logic from billing software. Discontinue tracking and billing of $0.05 EMC incentive payments for electronic claims submitted on or after this date. Verify that regression percentages (0-6%) remain unchanged and are based on annual prescription volume. Notify all participating pharmacies of the policy change. Failure to implement changes will result in incorrect reimbursement calculations and potential claim adjustments.