N.J. Admin. Code § 10:167-4.3 - Interchangeable drug products

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.
(b) If the prescriber does not specify to the contrary, the PAAD beneficiary has two options:
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.

Notes

N.J. Admin. Code § 10:167-4.3
Amended by R.1993 d.155, effective 4/5/1993.
See: 24 N.J.R. 4328(a), 25 N.J.R. 1514(a).
Amended by R.1998 d.176, effective 4/6/1998.
See: 29 N.J.R. 5280(a), 30 N.J.R. 1314(b).
Amended by R.2009 d.16, effective 1/5/2009.
See: 40 N.J.R. 4479(a), 41 N.J.R. 221(a).
Amended by 48 N.J.R. 1366(b), effective 7/5/2016

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