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Newsletter Vol. 3, No. 46
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
New Jersey Medicaid clarifies that pharmacies must obtain proper prescriber authorization (written statement of 'Brand Necessary' or 'Medically Necessary') when dispensing brand drugs when approved generic drugs are unavailable due to market supply fluctuations. Payments for brand drugs dispensed without proper authorization will be subject to recapture during pharmacy audits.
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What to do
immediately · 2 steps
01Healthcare practices prescribing in New Jersey must ensure providers write 'Brand Necessary' or 'Medically Necessary' on prescriptions when generic drugs are unavailable and brand drugs must be dispensed.
02Update prescription templates and educate providers on proper authorization language to prevent Medicaid payment recapture during pharmacy audits.
Original notice
Newsletter Vol. 3, No. 46
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 3, No. 01MediumNo effective date · Provider NoticeNewsletter Vol. 3, No. 02MediumNo effective date · Medical PolicyNewsletter Vol. 3, No. 03LowNo effective date · Provider NoticeNewsletter Vol. 3, No. 04LowEffective Jan 1, 2025 · PharmacyBrowse every New Jersey Medicaid change in the policy list