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-1.5 - Conditions for participation as a provider of pharmaceutical service

Universal Citation: NJ Admin Code 10:167A-1.5

Current through Register Vol. 56, No. 6, March 18, 2024

(a) All participating pharmacies shall provide services within the scope of the permit issued by the Board of Pharmacy of the State of New Jersey. Prescriptions must be dispensed in compliance with all current existing Federal and State laws.

(b) All drugs must be prescribed.

1. "Prescribed drugs" means simple or compounded substances or mixtures of substances prescribed for the cure, mitigation, or prevention of disease, or for health maintenance that are:

i. Dispensed by licensed pharmacists in accordance with regulations promulgated by the New Jersey State Board of Pharmacy, N.J.A.C. 13:39; and additional prescription pricing in accordance with P.L. 1994, c.67, as revised by P.L. 1995, c.5 (see 10:167A-1.15(b) ); and

ii. Dispensed by licensed pharmacists on the basis of a written, telephonic, or electronic prescription that is recorded and maintained in the pharmacist's records.

1. Inspect written prescriptions on file;

2. Audit records pertaining to covered persons;

3. Inspect private sector records, where deemed necessary to determine a pharmacy's usual and customary charges to the public.

i. Information pertaining to the patient's name, address, and prescriber will remain confidential within the limits of the law. Only the following items may be reviewed:

(1) Drug name;

(2) Quantity dispensed (including refills);

(3) Price;

(4) Prescription number (for reference purposes only);

(5) Date written and date dispensed;

(6) National Drug Code;

(7) Brand-drug dispensing authorizations;

(8) Other insurance payments;

(9) Patient payment liability amounts;

(10) Days supply;

(11) Usual and customary charge;

(12) Drug acquisition cost; and

(13) Customer certifications, such as manual or electronic signature log entries.

ii. The pharmacy shall provide sufficient information with regard to its contractual agreement(s) and payment history with other private third party prescription plans to identify and verify number of claims, amount paid, and dispensing fee paid by group contracts within the plan. Records and contracts shall be available on-site at the time of audit; or available within 10 working days of an on-site audit. Records shall include, but not be limited to:

(1) Payment vouchers;

(2) Contracts; and

(3) Agreements; and

4. Inspect acquisition records for the purchase of covered drugs based on the NDC numbers.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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