N.J. Admin. Code § 10:51-1.19

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

Section 10:51-1.19 - Prescription refill

(a) The provider shall submit a properly completed claim form or 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 must be indicated in writing by the prescriber on the original prescription or verbally when telephoning the original prescription to the pharmacist. Verbal instructions shall be reduced to writing by the pharmacist, in accordance with 45:14-14.

2. When the prescriber indicates a prescription refill(s) on an original or telephone prescription for drugs, the number of refills shall be limited to a maximum of five refills within a six-month period.

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. A telephone authorized refill for a prescription with no refill remaining must be assigned a new prescription number.

5. Prescription refills shall not be dispensed until a reasonable quantity (approximately 75 percent) of the medication originally dispensed or refilled could have been consumed in accordance with the prescriber's written directions for use.

i. Exception: When a prescription is lost or destroyed, requiring a replacement prescription to be dispensed before the original prescription could have been consumed in accordance with the prescriber's written directions for use, an original pharmacy claim with written justification shall be submitted to the fiscal agent for payment consideration.

N.J. Admin. Code § 10:51-1.19

Amended by R.1996 d.144, effective 3/18/1996.
See: 27 New Jersey Register 3907(a), 28 New Jersey Register 1524(a).
Amended by R.1996 d.146, effective 3/18/1996 (operative April 1, 1996).
See: 27 New Jersey Register 4566(a), 28 New Jersey Register 1526(a).
Amended by R.1997 d.251, effective 6/16/1997.
See: 28 New Jersey Register 2481(a), 28 New Jersey Register 3221(a), 29 New Jersey Register 2690(a).
In (a)2, inserted reference to telephone prescriptions; and deleted (a)2i, relating to an exception for oral contraceptives.
Recodified from N.J.A.C. 10:51-1.18 by 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. 10:51-1.19, Prescription Drug Price and Quality Stabilization Act, recodified to N.J.A.C. 10:51-1.20.
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.