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-1.9 - Compounded prescriptions
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Compounded prescriptions may be reimbursed by the Program. Compounded prescriptions are extemporaneously prepared mixtures of an active ingredient or ingredients and/or a pharmaceutical excipient or excipients and are dispensed by approved providers.
(b) Claims for compounded prescriptions may be manually or electronically submitted to the fiscal agent through a point-of-sale (POS) claim adjudication system approved by the Program. (See 10:167C-1.25.)
(c) Reimbursement for compounded prescriptions shall not exceed the lower of:
(d) For compounded prescriptions without an active ingredient(s), reimbursement is based on the cumulative cost of the pharmaceutical excipient(s).
(e) Reimbursement for compounded prescriptions submitted manually or as an EMC claim is calculated based on the ingredient cost, as described in 10:167C-1.5, of the most costly active ingredient, plus a dispensing fee, as described in 10:167C-1.7.
(f) The maximum charge for a compounded prescription must not exceed the limits set forth in 10:167C-1.14.
(g) Restrictions on payments for compounded prescriptions are as follows: