MedicaidReimbursementLow impact
Newsletter Vol. 4, No. 38
New Jersey Medicaid·NJ · Pharmacy, Ophthalmology·Provider Notice
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and related programs (PAAD, GA, CFD, GSHP, ADDP) have adjusted Federal Medicaid Upper Limits (MAC) for two pharmaceutical products effective July 2024. Hydrocortisone/Neomycin/Sulfate/Polymyxin B Sulfate (Cortisporin Otic Suspension) has an increased MAC price, while Chloramphenicol (Chloromycetin Ophthalmic Ointment) is no longer subject to MAC limits. Reimbursement for Chloramphenicol will now be based on the lower of AWP minus discounts plus dispensing fee or Usual and Customary Charge.
Action Required
By August 2024: Pharmacy billing team must update pharmaceutical pricing files and MAC limit tables in billing software to reflect the new Cortisporin Otic Suspension MAC price and remove the MAC limit for Chloramphenicol (Chloromycetin Ophthalmic). Verify that claims for Chloramphenicol now process using AWP-based reimbursement methodology instead of MAC pricing. Update manual records per the APPENDIX B maintenance instructions provided. This applies to New Jersey Medicaid, PAAD, GA, CFD, GSHP, and ADDP programs only. Failure to update pricing may result in claim denials or underpayment.