N.J. Admin. Code § 10:167C-1.12

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

Section 10:167C-1.12 - Covered pharmaceutical services

(a) All covered pharmaceutical services shall be provided within the scope of the Medicaid or Senior Gold programs, and billed to the fiscal agent on the claim form or other approved billing method (see N.J.A.C. 10:51, Appendix D, incorporated herein by reference, Fiscal Agent Billing Supplement).

(b) Covered pharmaceutical services include:

1. Prescribed legend drugs (for their medically accepted indication) as defined in Section 1927(k)(6) of the Social Security Act. "Legend drugs" mean those drugs whose labels include the legend statement "Caution: Federal Law Prohibits Dispensing without a prescription."; and

2. Non-legend drugs, as follow:

i. Diabetic testing materials;

ii. Insulin needles;

iii. Insulin; and

iv. Syringes and needles for injectable medicines for the treatment of multiple sclerosis.

N.J. Admin. Code § 10:167C-1.12