MedicaidReimbursementMedium impact
Newsletter Vol. 3, No. 15
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid and related programs (PAAD, GAP, CFGP, GSHP, ADDP) have delisted 7 pharmaceutical products from Federal Medicaid Upper Limits (MAC) reimbursement due to recent price changes, making them unavailable at MAC-eligible prices. Additionally, the MAC price for Aspirin/Methocarbamol (Robaxisal) has been reduced. Reimbursement for all affected drugs will now be based on the lower of AWP minus applicable discounts plus dispensing fee or Usual and Customary Charge.
Action Required
Immediately: Billing team must update pharmacy billing system to remove MAC reimbursement eligibility for the following delisted drugs: Aspirin/Butalbital/Caffeine (Fiorinal), Flurandrenolide (Cordran), Hydroflumethiazide (Diucardin), Sulfamethoxazole (Gantanol), Sulfanilamide (AVC), Trifluoperazine (Stelazine), and Trimipramine (Surmontil). Update the MAC price for Aspirin/Methocarbamol (Robaxisal) to the new lower rate in all claims processing systems. Configure billing software to default to AWP-based reimbursement calculation for delisted drugs rather than MAC for New Jersey Medicaid, PAAD, GAP, CFGP, GSHP, and ADDP claims. Notify pharmacy staff of the change. Failure to update pricing will result in claim denials or overpayments requiring adjustment.