MedicaidReimbursementLow impact

Newsletter Vol. 3, No. 23

Q: Who is affected by this change?

This affects New Jersey Medicaid Family Medicine, Internal Medicine, General Practice, Pain Management providers in NJ on Medicaid plans.

New Jersey Medicaid·NJ · Family Medicine, Internal Medicine, General Practice +1 more·Provider Notice

Effective date

Not stated

We identified it

Jun 20, 2026

Days to comply

—

Summary

New Jersey Medicaid has removed MAC (Maximum Allowable Cost) limits from four specific drugs due to market price changes. These drugs will now be reimbursed based on Average Wholesale Price minus discounts plus dispensing fee, or Usual and Customary Charge, whichever is lower.

Action Required

Action needed

Immediately: Pharmacy billing staff should update reimbursement expectations for Lortab, Darvocet-N, Bentyl, and Norpace CR in New Jersey Medicaid claims. These drugs are no longer subject to MAC pricing limits and will be reimbursed at AWP minus discounts plus dispensing fee or usual and customary charge, whichever is lower.

Related policy hubs

New Jersey Medicaid policies NJ policy changes Family Medicine Internal Medicine General Practice Pain Management