N.J. Admin. Code § 10:51-1.12

Current through Register Vol. 56, No. 11, June 3, 2024

Section 10:51-1.12 - Personal contribution to care requirements for NJ FamilyCare-Plan C and copayments for NJ FamilyCare-Plan D

(a) General policies regarding the collection of personal contribution to care for NJ FamilyCare-Plan C and copayments for NJ FamilyCare-Plan D are set forth at N.J.A.C. 10:49-9.

(b) Personal contribution to care for NJ FamilyCare-Plan C services are $ 1.00 per dispensing for generics and $ 5.00 per dispensing for brand name drugs. Included in drugs are insulin, needles and syringes.

(c) Pharmacies are required to collect the personal contribution to care for the above-mentioned NJ FamilyCare-Plan C services if the NJ FamilyCare Identification Card indicates that a personal contribution to care is required and the beneficiary does not have a NJ FamilyCare form which indicates that the beneficiary has reached their cost share limit and no further personal contributions to care are required, until further notice. Personal contribution to care charges cannot be waived.

(d) The copayment for prescription drugs under NJ FamilyCare-Plan D shall be $ 5.00 per prescription:

1. If greater than a 34-day supply of a prescription drug is dispensed, a $ 10.00 copayment shall apply.

(e) Pharmacies shall collect the copayment specified in (d) above. Copayments shall not be waived.

N.J. Admin. Code § 10:51-1.12

New Rule, R.1998 d.154, effective 2/27/1998 (operative March 1, 1998; to expire August 31, 1998).
See: 30 New Jersey Register 1060(a).
Former N.J.A.C. 10:51-1.12, Noncovered pharmaceutical services, recodified to N.J.A.C. 10:51-1.13.
Adopted concurrent proposal, R.1998 d.487, effective 8/28/1998.
See: 30 New Jersey Register 1060(a), 30 New Jersey Register 3519(a).
Readopted the provisions of R.1998 d.154 without change.
Amended by R.1999 d.211, effective 7/6/1999 (operative August 1, 1999).
See: 31 New Jersey Register 998(a), 31 New Jersey Register 1806(a), 31 New Jersey Register 2879(b).
In (a), added reference to copayments for NJ KidCare-Plan D; added (d) and (e).
Amended by R.2004 d.26, effective 1/20/2004.
See: 35 New Jersey Register 3788(a), 36 New Jersey Register 558(a).
Substituted "NJ FamilyCare" for "NJ KidCare" throughout.