MedicaidReimbursementLow impact
Newsletter Vol. 5, No. 16
New Jersey Medicaid·NJ · Ophthalmology·Provider Notice
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has removed the Maximum Allowable Cost (MAC) limits for Bacitracin Zinc Polymyxin B Sulfate ophthalmic ointment (Polysporin) effective January 2025. Reimbursement will now be based on the lower of Average Wholesale Price minus discounts plus dispensing fee, or Usual and Customary Charge.
Action Required
Immediately: Billing team should update pharmacy billing systems to reflect removal of MAC limits for Bacitracin Zinc Polymyxin B Sulfate ophthalmic ointment. Verify reimbursement calculations are now based on AWP minus discounts plus dispensing fee or U&C charge, whichever is lower.