New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 167C - PROVISION OF PHARMACEUTICAL SERVICES UNDER THE SENIOR GOLD PROGRAM
Subchapter 1 - REQUIREMENTS FOR PROVISION OF PHARMACEUTICAL SERVICES
Section 10:167C-1.18 - Prescription refill
Universal Citation: NJ Admin Code 10:167C-1.18
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The provider shall submit a properly completed claim form or electronic claim in the proper EMC claim format to the fiscal agent for reimbursement of an allowable refill. An allowable refill shall comply with the following instructions in order to be reimbursed as such:
1. Refill instructions must be indicated in writing by
the prescriber on the original prescription or verbally when telephoning the original prescription to the
pharmacist. Verbal instructions shall be reduced to writing by the pharmacist, in accordance with
45:14-14.
2. The
original prescription is valid for the 12-month period beginning with the date of the original prescription.
There is no limit to the number of refills dispensed during the 12-month period.
i. Exception: Oral contraceptives originally prescribed for three ovulatory
cycles may be refilled up to three times within one year if so indicated by the prescriber on the original
prescription.
3. A telephone authorized refill for a
prescription with no refill remaining must be assigned a new prescription number.
4. Prescription refills shall not be dispensed until a reasonable quantity
(approximately 85 percent) of the medication originally dispensed or refilled could have been consumed in
accordance with the prescriber's written directions for use.
i. Exception:
When a prescription is lost or destroyed, requiring a replacement prescription to be dispensed before the
original prescription could have been consumed in accordance with the prescriber's written directions for
use, and original pharmacy claim with written justification must be submitted to the fiscal agent for payment
consideration.
5. When Senior Gold is the secondary
payer to the Medicare Prescription Drug Program, any days supply standards required pursuant to the Medicare
Prescription Drug, Improvement and Modernization Act of 2003,
Pub. L. 108-173, effective
December 8, 2003 and the rules promulgated thereunder at
42 CFR §
423.1 et seq. shall supersede the requirements set forth in
10:167C-1.18.
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