N.J. Admin. Code § 10:167A-1.9

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

Section 10:167A-1.9 - Prescription drug dispensing fee

(a) The dispensing fee for each prescription dispensed to recipients by providers having retail permits, and where PAAD is the primary payer is $ 3.73 to $ 3.99. Additional dispensing fees (add-ons) per prescription shall be given, when PAAD is the primary payer, 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 PAAD beneficiaries opportunities to utilize this service.

2. Impact area location: $ 0.15. The provider shall have a combined Medicaid and PAAD primary prescription volume, as calculated by DMAHS, 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, 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 PAAD program determines that the provider was not entitled to reimbursement for them.

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

N.J. Admin. Code § 10:167A-1.9

Amended by R.1997 d.252, effective 6/16/1997.
See: 28 N.J.R. 2481(a), 28 N.J.R. 3221(a), 29 N.J.R. 2678(a).
Recodified from N.J.A.C. 8:83C-1.7 by R.2003 d. 248, effective 6/16/2002.
See: 34 N.J.R. 3456(a), 35 N.J.R. 2642(a).
Former N.J.A.C. 8:83C-1.9, Compounded prescriptions, recodified to N.J.A.C. 8:83C-1.11.
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