Summary
New Jersey Medicaid is updating its Maximum Allowable Cost (MAC) drug list for pharmaceutical services. Providers must replace the previous MAC drug list (Appendix B) with the revised version effective January. This affects reimbursement limits for multiple brand-name and generic drugs covered under Medicaid and the Pharmaceutical Assistance to the Aged and Disabled (PAAD) program.
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What to do
Action · 4 steps
01By January 2024: Billing and pharmacy teams must obtain the revised MAC Drug List (Appendix B, Rev.) from the provided source.
02Replace the outdated Appendix B from Newsletter Volume No. (July) with the new version in your Pharmaceutical Services Manual.
03Verify that billing system drug pricing tables reflect the updated MAC limits to ensure accurate claim submission and reimbursement.
04Contact the New Jersey Medicaid programs Chief Pharmaceutical Consultant or your local Medicaid District Office if clarification is needed on specific drug coverage or prior authorization requirements.
If missed: Failure to update pricing tables may result in claim rejections or overpayments.
Original notice
Newsletter Vol. 5, No. 02
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 2, No. 66HighEffective Dec 1, 2023 · PharmacyNewsletter Vol. 3, No. 05MediumNo effective date · Provider NoticeNewsletter Vol. 3, No. 32MediumEffective Aug 1, 2024 · Provider NoticeNewsletter Vol. 3, No. 47MediumNo effective date · Provider NoticeBrowse every New Jersey Medicaid change in the policy list