MedicaidReimbursementMedium impact
Newsletter Vol. 5, No. 02
New Jersey Medicaid·NJ · Pharmacy·Reimbursement
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
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.
Action Required
By January 2024: Billing and pharmacy teams must obtain the revised MAC Drug List (Appendix B, Rev.) from the provided source. Replace the outdated Appendix B from Newsletter Volume No. (July) with the new version in your Pharmaceutical Services Manual. Verify that billing system drug pricing tables reflect the updated MAC limits to ensure accurate claim submission and reimbursement. Contact 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. Failure to update pricing tables may result in claim rejections or overpayments.