MedicaidReimbursementMedium impact
Newsletter Vol. 2, No. 10
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
We identified it
Jun 20, 2026
Summary
Two pharmaceutical products (Desipramine HCl/Norpramin and Verapamil HCl/Calan/Isoptin tablets) have been removed from the New Jersey Medicaid Maximum Allowable Cost (MAC) list due to recent price changes. Reimbursement for these drugs will now be based on the lower of Average Wholesale Price (AWP) or Usual and Customary Charge instead of MAC limits.
Action Required
Immediately: Pharmacy billing team must update reimbursement calculation rules in billing software to remove Desipramine HCl (Norpramin) tablets and Verapamil HCl (Calan/Isoptin) tablets from MAC-based pricing. Configure system to process claims for these two drugs using AWP or Usual and Customary Charge (whichever is lower) for all New Jersey Medicaid beneficiaries (PAAD and GA programs). Verify that prior claims processed under MAC limits are not affected. Update internal pharmacy formulary documentation to reflect MAC list deletion. Contact New Jersey Medicaid program Chief Pharmacy Consultant if clarification needed on pricing methodology.