MedicaidReimbursementMedium impact
Newsletter Vol. 4, No. 31
New Jersey Medicaid·NJ · Pharmacy·Reimbursement
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
This policy updates the Maximum Allowable Cost (MAC) drug list for pharmaceutical services covered under New Jersey Medicaid. Providers must replace their current MAC drug list (Appendix B) with the revised July version to ensure accurate reimbursement and billing compliance.
Action Required
By July 31, 2024: Billing team and pharmacy staff must obtain the revised MAC Drug List (Appendix B Rev) from the policy document and replace the current list in their pharmaceutical services manual. Update all billing systems, pharmacy management software, and price verification tools to reflect the new MAC limits. Verify that all HCPCS J-codes and drug products currently being billed match the updated list. Contact the New Jersey Medicaid program's Chief Pharmaceutical Consultant if discrepancies exist between old and new MAC limits. Failure to use the current MAC list will result in claim denials or recoupment for overages billed above the MAC threshold.