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-1.6 - Program restrictions affecting payment for prescribed drugs

Universal Citation: NJ Admin Code 10:167A-1.6

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

(a) The choice of prescribed drugs shall be at the discretion of the prescriber within the limits of applicable laws. However, the prescriber's discretion is limited for certain drugs. Reimbursement may be denied if any of the following, or any of the requirements of this chapter are not met:

1. Prescription Drug Price and Quality Stabilization Act (N.J.S.A. 24:6E-1 et seq.) (see N.J.A.C. 10:167A-1.21 ) and Non-Proprietary or generic dispensing (see N.J.A.C. 10:167A-1.12 );

2. Federal regulations ( 42 CFR 447.500, 512-516 ) that set the aggregate upper limits on payment for certain multi-source drugs if Federal Financial Participation (FFP) is to be made available. The limit applies to all "maximum allowable cost" drugs (see N.J.A.C. 10:167A-1.7, Basis of payment); and

3. Drug Efficacy Study Implementation (DESI): "Less than effective drugs" subject to a Notice of Opportunity for Hearing (NOOH) by the Federal Food and Drug Administration (see 10:167A-1.22 ) and listing of DESI drugs in (N.J.A.C. 10:51, Appendix A).

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