MedicaidAdministrativeMedium impact
Newsletter Vol. 3, No. 46
New Jersey Medicaid·NJ·Pharmacy
We identified it
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.
Action Required
Immediately: Healthcare 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. Update prescription templates and educate providers on proper authorization language to prevent Medicaid payment recapture during pharmacy audits.