MedicaidReimbursementLow impact
Newsletter Vol. 5, No. 06
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has removed Federal Medicaid Upper Limits (MAC) for two medications: Primidone 250mg tablets and Verapamil Hydrochloride 240mg tablets. Reimbursement will now be based on the lower of Average Wholesale Price minus regression discounts plus dispensing fee, or Usual and Customary Charge.
Action Required
Immediately: Pharmacy billing staff should update reimbursement calculations for Primidone 250mg tablets (Mysoline) and Verapamil Hydrochloride 240mg tablets (Calan, Isoptin) to use AWP minus regression discounts plus dispensing fee or usual and customary charge, whichever is lower, for New Jersey Medicaid claims.