Summary
New Jersey Medicaid is adding five pharmaceutical manufacturers to its rebate program (SmithKlineBeecham, AmericanPharmacal, WarnerLambert, NomaxIncorporated, MedImmune, IOMEDLaboratories) and removing three (ManufacturingChemistsInc, CetusOncology, Pharmakraft). Drugs from deleted manufacturers will no longer be reimbursed by Medicaid effective the specified dates. Providers must verify manufacturer participation status before dispensing or billing for covered drugs.
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What to do
Action · 6 steps
01Pharmacy and billing teams must immediately.
02Cross-reference all current drug inventories and pending prescriptions against the added and deleted manufacturer lists.
03Update pharmacy systems and formulary records to reflect the new participating manufacturers and removed manufacturers.
04Flag any pending claims for drugs manufactured by the three deleted manufacturers (ManufacturingChemistsInc, CetusOncology, Pharmakraft) for manual review and potential denial processing.
05Communicate with prescribers and patients that drugs from deleted manufacturers will not be covered.
06Verify effective dates for each addition/deletion on the referenced Appendix E (not fully provided in this notice) before processing claims.
If missed: Failure to implement these changes will result in claim denials for non-participating manufacturers and potential patient balance issues.
Original notice
Newsletter Vol. 5, No. 28
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 1, No. 08MediumNo effective date · PharmacyNewsletter Vol. 2, No. 64LowEffective Dec 1, 2024 · Provider NoticeNewsletter Vol. 3, No. 51MediumNo effective date · Provider NoticeNewsletter Vol. 4, No. 18HighNo effective date · Provider NoticeBrowse every New Jersey Medicaid change in the policy list