MedicaidReimbursementMedium impact
Newsletter Vol. 5, No. 02
New Jersey Medicaid·NJ·Reimbursement
We identified it
Jun 20, 2026
Summary
Federal Upper Limits of Payment for MAC (Maximum Allowable Cost) drugs have been revised, which will affect reimbursement rates for prescription medications. Billing teams need to update their fee schedules and payment expectations for affected pharmaceutical products.
Action Required
Immediately: Billing team must download and review the revised Federal Upper Limits document from the source URL to identify specific drugs with updated payment limits. Update billing system fee schedules for affected MAC drugs. Monitor payment adjustments and denials for pharmaceutical claims to ensure proper reimbursement under new limits.