MedicaidReimbursementLow impact
Newsletter Vol. 2, No. 27
New Jersey Medicaid·NJ·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has removed three drugs from Maximum Allowable Cost (MAC) pricing limits due to market price increases. Gentamicin sulfate ointment, Primidone tablets, and Trihexyphenidyl HCl tablets will now be reimbursed based on average wholesale price minus discount plus dispensing fee, rather than MAC pricing.
Action Required
Immediately: Pharmacy billing staff in New Jersey should update reimbursement expectations for Gentamicin sulfate ointment, Primidone tablets, and Trihexyphenidyl HCl tablets. These drugs will now be reimbursed at average wholesale price minus regression discount plus dispensing fee rather than MAC pricing for all New Jersey Medicaid programs.