New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 167A - PROVISION OF PHARMACEUTICAL SERVICES UNDER THE PHARMACEUTICAL ASSISTANCE TO THE AGED AND DISABLED PROGRAM (PAAD)
Subchapter 1 - REQUIREMENTS FOR PROVISION OF PHARMACEUTICAL SERVICES
Section 10:167A-1.11 - Compounded prescriptions

Universal Citation: NJ Admin Code 10:167A-1.11

Current through Register Vol. 56, No. 18, September 16, 2024

(a) Compounded prescriptions may be reimbursed by the PAAD program. Compounded prescriptions are extemporaneously prepared mixtures of an active ingredient or ingredients and are dispensed by approved providers.

(b) Claims for compounded prescriptions shall be electronically submitted to the fiscal agent through a point-of-sale (POS) claim adjudication system approved by the PAAD program. (See N.J.A.C. 10:167A-1.27) .

1. A compounded prescription is indicated by the provider by the use of the "compound drug" indicator field in the EMC claim format.

(c) Reimbursement for compound prescriptions shall be:

1. In accordance with N.J.A.C. 10:167A-1.7 plus a dispensing fee, as described in N.J.A.C. 10:167A-1.9; or

2. A provider's usual and customary charge.

(d) The maximum charge for a compounded prescription must not exceed the limits set forth in 10:167A-1.16

(e) Restrictions on payments for compounded prescriptions are as follows:

1. All legend ingredients that are contained in compounded prescriptions shall be covered by the PAAD program in accordance with N.J.A.C. 10:167A-1.14 and 1.15.

2. Compounded prescriptions containing drugs not eligible for reimbursement under 10:167A-1.15 are not covered.

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