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-1.7 - Prescription drug dispensing fee

Universal Citation: NJ Admin Code 10:167C-1.7

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

(a) The dispensing fee for each prescription, dispensed by providers having retail permits to recipients other than those in nursing facilities, is $ 3.73. Additional dispensing fees (add-ons) per prescription shall be given to pharmacy providers who provide the following:

1. Twenty-four hour emergency service: $ 0.11. The provider shall have a 24-hour per day, 365 days per year prescription service available and shall have provided Senior Gold beneficiaries opportunities to utilize this service.

2. Patient consultations: $ 0.08. In addition to routinely monitoring recipient profiles for drug interactions, contra-indications, allergies, etc., the provider shall, where appropriate, discuss the course of drug therapy with the recipient. This discussion must include emphasis on compliance with the prescriber's orders; proper drug utilization; cautions about possible side effects; foods to avoid; proper drug storage conditions; and any other information that will prove beneficial to the recipient while on drug therapy.

3. Impact area location: $ 0.15. The provider shall have a combined Medicaid and Senior Gold prescription volume equal to or greater than 50 percent of the provider's total prescription volume.
i. The nursing facility prescription volume shall be included for the determination of total prescription volume in determining entitlement to the impact allowance.

(b) Price information is supplied from a reference drug file subcontracted for this purpose by the fiscal agent and accepted by the Division as the primary source of pricing information for the New Jersey Medicaid Management Information System (NJMMIS). The calculated price shall not exceed the lower of the average wholesale price (AWP) or the Federal Fund Participation Upper Limit (FFPUL) as supplied by the reference drug file contractor.

(c) In order to receive any or all of the above increments, the provider shall certify annually to the Division on Form FD-70, that the services(s) as defined in (a) above, are being provided and/or that the provider is entitled to the impact increment as defined in (a) above.

1. Each claimed increment is subject to audit and retroactive recovery with appropriate penalties, if warranted, if the Program determines that the provider was not entitled to reimbursement for them.

(d) Failure to submit this report annually shall result in retail pharmacy provider payments based on the basic dispensing fee of $ 3.73.

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.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.