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Newsletter Vol. 5, No. 01
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
New Jersey Medicaid will only cover brand-name drugs when medically necessary and the prescriber writes 'Brand Medically Necessary' in their own handwriting on each prescription. The state is cracking down on unnecessary brand drug prescribing to control costs and encourage generic alternatives.
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What to do
immediately · 3 steps
01Notify all providers that for New Jersey Medicaid patients requiring brand-name drugs, they must handwrite 'Brand Medically Necessary' on each prescription when generics are available but medically inappropriate.
02Update prescription pads and EMR alerts for NJ Medicaid patients.
03Educate providers to carefully consider generic alternatives except when brand therapy is truly medically necessary to avoid claim denials.
Original notice
Newsletter Vol. 5, No. 01
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 3, No. 46MediumNo effective date · PharmacyNewsletter Vol. 5, No. 28MediumNo effective date · Provider NoticeNewsletter Vol. 5, No. 29HighEffective May 1, 2024 · Prior AuthorizationNewsletter Vol. 5, No. 30MediumEffective May 1, 1995 · CodingBrowse every New Jersey Medicaid change in the policy list