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Newsletter Vol. 2, No. 10
Act
immediately
Effective date
Not stated in the notice
Identified
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.
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What to do
immediately · 5 steps
01Pharmacy 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.
02Configure 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).
03Verify that prior claims processed under MAC limits are not affected.
04Update internal pharmacy formulary documentation to reflect MAC list deletion.
05Contact New Jersey Medicaid program Chief Pharmacy Consultant if clarification needed on pricing methodology.
Original notice
Newsletter Vol. 2, No. 10
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 2, No. 01HighEffective Jan 1, 2025 · Provider NoticeNewsletter Vol. 2, No. 02HighEffective Jan 1, 2024 · ReimbursementNewsletter Vol. 2, No. 03MediumNo effective date · CodingNewsletter Vol. 2, No. 04HighEffective Dec 1, 1991 · Provider NoticeBrowse every New Jersey Medicaid change in the policy list