Current through Register Vol. 54, No. 7, April 4, 2022
(a) Whenever PAAD
is the primary payer and any interchangeable drug product is available for the
prescription written, the PAAD Program shall reimburse for multisource generic
drugs without prior authorization, but not for multisource brand name drugs
without prior authorization.
the prescriber does not specify to the contrary, the PAAD beneficiary has two
1. To purchase an interchangeable
drug product which is equal to or less than the maximum allowable cost, at the
PAAD co-pay; or
2. To purchase the
prescribed drug product, which is higher in cost than the maximum allowable
cost and pay in full.
(c) If the prescriber specifies on the
prescription that substitution is not permitted, and that the brand name drug
is medically necessary, when required, the PAAD Program shall reimburse for the
reasonable cost of the prescribed product, less the PAAD co-pay pursuant to the
requirements respecting prior authorization set forth in the Fiscal Year 2016
Appropriations Act, P.L. 2015, c. 63, approved June 26, 2015, as amended and
supplemented by subsequent State appropriations acts.
N.J. Admin. Code §
Amended by R.1993 d.155,
See: 24 N.J.R. 4328(a), 25 N.J.R. 1514(a).
Amended by R.1998 d.176,
See: 29 N.J.R. 5280(a), 30 N.J.R. 1314(b).
Amended by R.2009 d.16,
See: 40 N.J.R. 4479(a), 41 N.J.R. 221(a).
N.J.R. 1366(b), effective