MedicaidCoverageHigh impact
Newsletter Vol. 2, No. 23
New Jersey Medicaid·NJ · Pharmacy, General Practice·Pharmacy
We identified it
Jun 20, 2026
Summary
The New Jersey Medicaid program and affiliated health plans (PAAD, General Assistance, Garden State Health Plan, Cystic Fibrosis Drug program) will no longer reimburse for drugs listed under the federal Drug Efficacy Study Implementation (DESI) program, which are considered less than effective. Providers must reference the updated DESI drug list (provided in NDC order) and stop billing for these medications effective immediately.
Action Required
Immediately: Billing team must obtain and review the updated DESI drug list (provided as attachment in sequential National Drug Code/NDC order) referenced in this policy. Update pharmacy billing system to block claims for all drugs listed on the current DESI list across all affected New Jersey plans (Medicaid, PAAD, General Assistance, Garden State Health Plan, Cystic Fibrosis Drug program). Notify pharmacy providers and physicians that prescriptions for DESI-listed drugs will be denied for reimbursement. Discard any previous DESI lists distributed before October (prior version). Contact the New Jersey Medicaid program Chief Pharmacy Consultant with questions. Claims submitted for DESI-listed drugs will be denied.