N.J. Admin. Code § 10:167C-1.8

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

Section 10:167C-1.8 - Senior Gold Program co-payment

(a) Beneficiaries in the Program are responsible for a part of the cost of drugs and devices covered by the Program. At the point of sale, a Senior Gold beneficiary shall render to a pharmacy provider a fixed co-payment of $ 15.00 plus 50 percent of the remaining cost of the drug.

(b) A co-payment shall be rendered to a pharmacy provider for each original or refill prescription dispensed. The provider's usual and customary charge billed to the Program shall be inclusive of the co-payment amount which will be deducted by the New Jersey Medicaid Management Information System (NJMMIS).

1. Under no circumstances is the required rendered co-payment amount to be waived for reasons of promotion, advertisement and/or competitive considerations. Failure to comply with Program co-payment requirements may result in a suspension of a provider's approval to participate in the Program.

N.J. Admin. Code § 10:167C-1.8