New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 51 - PHARMACEUTICAL SERVICES MANUAL
Subchapter 2 - PHARMACEUTICAL SERVICES TO MEDICAID OR NJ FAMILYCARE FEE-FOR-SERVICES BENEFICIARIES IN A NURSING FACILITY
Section 10:51-2.4 - Program restrictions affecting payment of prescribed drugs

Universal Citation: NJ Admin Code 10:51-2.4

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

(a) The choice of prescribed drugs shall be at the discretion of the prescriber within the limits of applicable laws. However, the prescriber's discretion is limited for certain drugs. Reimbursement may be denied if any of the following requirements, or any of the requirements of the rules of this subchapter, are not met:

1. Prescription Drug Price and Quality Stabilization Act (24:6E-1 et seq.) (see 10:51-2.17);
i. Products listed in N.J.A.C. 8:71 (hereafter referred to as "the Formulary"), and all subsequent revisions, distributed to all prescribers and pharmacists; and

ii. Non-proprietary or generic dispensing (see 10:51-2.9);

(b) On and after July 1, 2006, payments for erectile dysfunction drugs shall be limited to four treatments per month for male beneficiaries over the age of 18 who have a diagnosis of erectile dysfunction and who are not registered on New Jersey's Sex Offender Registry.

1. The face of the prescription shall contain the statement "Diagnosis of erectile dysfunction," written by the prescriber.

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