All PlansPrior AuthMedium impact
Newsletter Vol. 2, No. 67
New Jersey Medicaid·NJ·Prior Authorization
We identified it
Jun 20, 2026
Summary
A new Prospective Drug Utilization Review (DUR) program has been established that will require prior authorization or review for certain medications before they can be prescribed or dispensed. This policy affects medication prescribing and may impact billing for drug administration or medication-related services.
Action Required
Immediately: Review the full policy document at https://www.njmmis.com/documentDownload.aspx?document=2-67.pdf to understand specific DUR requirements. Providers must verify if prescribed medications require prior authorization before prescribing. Billing team should update workflows to check DUR requirements for medication-related claims to prevent denials.