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New Jersey MedicaidMedicaid · Reimbursement · Provider Notice · NJ · PharmacyMedium impact

Newsletter Vol. 3, No. 47

Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

New Jersey Medicaid program is deleting specific pharmaceutical drugs from the Federal Medicaid Upper Limits (MAC) list effective June, July, and August. Affected drugs include Amiloride Hydrochloride, Butabarbital Sodium, Dexchlorpheniramine Maleate, Chloramphenicol, Potassium Chloride, Sulfacetamide Sodium, and Aspirin/Oxycodone combinations. Reimbursement will now be based on the lower of AWP minus applicable discounts plus dispensing fee or Usual and Customary Charge for all New Jersey Medicaid programs (Medicaid, PAAD, GAP, CFDP, GSHP, and ADDP).

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What to do

immediately · 6 steps
01Pharmacy billing team must update reimbursement logic in billing software for the following drugs removed from MAC list: Amiloride Hydrochloride (Midamor), Butabarbital Sodium (Butisol), Dexchlorpheniramine Maleate (Polaramine), Chloramphenicol (Chloromycetin), Potassium Chloride (Micro-K Extencaps), Sulfacetamide Sodium (Isopto Cetamide, Sodium Sulamyd), and Aspirin/Oxycodone Hydrochloride (Percodan).
02Configure system to calculate reimbursement using the lower of.
03AWP minus regression discounts (if applicable) plus dispensing fee.
04Usual and Customary Charge for all programs: New Jersey Medicaid, PAAD, GAP, CFDP, GSHP, and ADDP.
05Effective dates: June (Amiloride, Butabarbital, Dexchlorpheniramine), July (Chloramphenicol, Potassium Chloride, Sulfacetamide Sodium), August (Aspirin/Oxycodone).
06Claims submitted without updated pricing logic will be denied or require manual adjustment, resulting in delayed reimbursement.

Original notice

Newsletter Vol. 3, No. 47
njmmis.com · Always check the source before changing claims.
View original ↗

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