N.J. Admin. Code § 10:167A-1.20

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:167A-1.20 - Prescription refill

(a) The provider shall submit an electronic claim in the proper EMC claim format to the fiscal agent for reimbursement of an allowable refill. An allowable refill shall comply with the following instructions in order to be reimbursed as such:

1. Refill instructions shall be indicated in writing by the prescriber on the original prescription, on a facsimile of the prescription, in the electronic prescription, or verbally when telephoning the original prescription to the pharmacist. Verbal instructions shall be reduced to writing by the pharmacist.

2. The original prescription is valid for the 12 month period beginning with the date of the original prescription. There is no limit to the number of refills dispensed during the 12 month period.

i. Exception: Oral contraceptives originally prescribed for three ovulatory cycles may be refilled up to three times within one year if so indicated by the prescriber on the original prescription.

3. Refill instructions indicating "refill prn" or indicating more than five refills, shall be subject to the limits imposed in (a)2 above, and shall be reimbursed up to these limits only.

4. An authorized refill for a prescription with no refill remaining must be assigned a new prescription number.

5. Prescription refills shall not be dispensed until 85 percent of the medication originally dispensed or refilled could have been consumed in accordance with the prescriber's written directions for use.

N.J. Admin. Code § 10:167A-1.20

Amended by R.1996 d.144, effective 3/18/1996.
See: 27 N.J.R. 3907(a), 28 N.J.R. 1524(a).
Amended by R.1996 d.146, effective 3/18/1996 (operative April 1, 1996).
See: 27 N.J.R. 4566(a), 28 N.J.R. 1526(a).
Recodified from N.J.A.C. 8:83C-1.18 by R.2003 d. 248, effective 6/16/2003.
See: 34 N.J.R. 3456(a), 35 N.J.R. 2642(a).
Former N.J.A.C. 8:83C-1.20, Drug efficacy study implementation (DESI), recodified to N.J.A.C. 8:83C-1.22.
Amended by R.2009 d.293, effective 10/5/2009.
See: 41 N.J.R. 1637(a), 41 N.J.R. 3804(a).

Amended by 49 N.J.R. 446(a), effective 3/6/2017