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-1.3 - Conditions for participation as a provider of pharmaceutical services
Universal Citation: NJ Admin Code 10:167C-1.3
Current through Register Vol. 56, No. 18, September 16, 2024
(a) All participating pharmacies shall provide complete prescription services, including injectables and injectable anti-neoplastic agents, compounding, and prescription refill services, when allowable. Prescriptions must be dispensed in compliance with all current existing Federal and State laws.
(b) All drugs must be prescribed.
1. "Prescribed drugs" mean simple or compounded substances or
mixtures of substances prescribed for the cure, mitigation, or prevention of disease, or for health
maintenance that are:
i. Prescribed by a practitioner licensed or
authorized by the State of New Jersey, or the state in which he or she practices, to prescribe drugs and
medicine within the scope of his or her license and practice;
ii.
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 information in accordance with P.L. 1994, c.67,
as revised by P.L. 1995, c.5 (see 10:167C-1.13(b) ); and
iii. Dispensed by a licensed pharmacist on the basis of a written
prescription that is recorded and maintained in the pharmacist's records.
(c) Participating pharmacies shall permit properly identified representatives of the Division of Medical Assistance and Health Services or the Department to:
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;
(3)
Price;
(4) Prescription number (for reference purposes only);
and
(5) Date dispensed.
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 records of purchases of covered drugs for which claims have been
made for reimbursement.
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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