New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 51 - PHARMACEUTICAL SERVICES MANUAL
Subchapter 1 - PHARMACEUTICAL SERVICES
Section 10:51-1.20 - Prescription Drug Price and Quality Stabilization Act
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The Prescription Drug Price and Quality Stabilization Act, 24:6E-1 et seq., shall apply to the New Jersey Medicaid and NJ FamilyCare programs. This law requires that every prescription blank contain the statements "Substitution Permissible" and "Do Not Substitute." The prescriber shall initial one of the statements in addition to signing the prescription blank.
(b) Federal regulations prescribe the aggregate upper limit, for which Federal Financial Participation (FFP) is available, that Medicaid or NJ FamilyCare-Plan A may reimburse for certain multi-source drugs. The limit shall apply to all listed MAC drugs (see Appendix B) unless the prescriber indicates in his or her own handwriting on each written prescription or follow-up written prescription to a telephone rendered prescription (see 10:51-1.9) the phrase "Brand Medically Necessary." The Federal regulation requires a handwritten statement and does not permit the use of alternatives such as a check-off box, initials or prescriber's signature, next to a preprinted statement "Do Not Substitute," nor does it allow a hand written statement "Do Not Substitute." For purposes of reimbursement, the physician's override capability under 24:6E-1 does not apply to drugs which have a Federal MAC limit. The Division shall also apply these Federal requirements to NJ FamilyCare-Plans B and C.
(c) Blanket authorization denying substitutions shall not be permitted. Each prescription order shall state "Brand Medically Necessary" in the prescriber's own handwriting. For non-MAC drugs, each prescription order shall follow the requirements of 24:6E-1 et seq. (see (a) above).
(d) For claims with service dates on or after July 1, 1999, the pharmacist shall dispense the least expensive, therapeutically effective nutritional supplement or specialized infant formula, at the time of dispensing, unless the prescriber indicates in his or her own handwriting on each written prescription or follow-up written prescription to a telephone rendered prescription the phrase "Brand Medically Necessary."
(e) The dispenser must always report the actual labeler code and drug product code of the drug dispensed. The package size code reported may differ from the stock package size used to fill the prescription.
(f) The "Brand Medically Necessary" requirement for MAC prescriptions shall not apply for Medicaid or NJ FamilyCare beneficiaries enrolled in a Medicaid or NJ FamilyCare participating Health Maintenance Organization (HMO).