Government of New Brunswick

The New Brunswick Drug Plans Formulary is a list of the drugs which are eligible benefits under the NB Drug Plans (New Brunswick Prescription Drug Program and New Brunswick Drug Plan). All drugs considered for listing as benefits must be reviewed according to the Drug Review Process.

Most drugs listed in the Formulary are “regular” benefits which are reimbursed with no criteria or prior approval requirements. Some drugs require Special Authorization in order to be reimbursed.  Certain drug products are not eligible benefits and are identified on the exclusion list in the Formulary.

The NB Drug Plan Formulary is updated monthly.

Reimbursement of brand name products when generics exist

When generic products are available for a brand name drug, the NB Drug Plans will only reimburse pharmacies for the lowest cost generic product. Beneficiaries, who choose to receive a brand name product when a generic product exists, are responsible for paying any difference in price.

The NB Drug Plans will consider requests for reimbursement of brand name drugs when a beneficiary has had a hypersensitivity reaction (e.g. edema, respiratory distress, serum sickness, anaphylaxis) to a non-medicinal ingredient contained in the generic product. Requests may be made by submitting a completed Special Authorization Request Form and providing details of the hypersensitivity reaction.

Information on the safety and effectiveness of generic drugs is available on Health Canada’s website at http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/med/med-gen-eng.php.

 

 

Special Authorization

Certain drugs are eligible for coverage under the NB Drug Plans through special authorization.

Drugs listed as special authorization benefits have specific criteria that must be met before they are approved for reimbursement.  The criteria are developed by the expert advisory committees based on the evidence considered in the Drug Review Process.

To request coverage through special authorization, the requestor must provide all of the required information in the general request form or the specific request form for the following drugs and conditions:    

Request forms

All drugs approved through special authorization may be subject to a renewal process. Additional information may be required to ensure that the drug is having the expected effect and is still needed.  

Special authorization requests should be sent by mail or FAX to:

Special Authorization Unit
New Brunswick Drug Plans
P.O. Box 690
Moncton, NB E1C 8M7
Local Fax: 506-867-4872
Toll Free Fax: 1-888-455-8322
Inquiry Line: 1-800-332-3691

Drugs ineligible for consideration through special authorization

  • Drugs determined to be non-benefits further to an expert advisory committee’s review and recommendation that they not be reimbursed.
  • Drugs not yet reviewed or still under review 
  • The drug is being provided, or paid for, by another source 
  • Drugs not authorized for sale and use in Canada (e.g. drugs obtained through Health Canada’s Special Access Program, experimental or investigational drugs) 
  • Products excluded as benefits as identified on the exclusion list in the Formulary  

Requests for drugs not listed in the formulary

Under exceptional circumstances, requests for drugs not listed in the formulary or for an indication not included in the special authorization criteria, may be reviewed on a case-by-case basis.  This does not include drugs that are ineligible for consideration through special authorization.

Requests must be in writing and include the following information:

  • Dose and administration frequency of the requested drug
  • Diagnosis or description of the patient’s medical condition
  • Relevant previous therapies tried along with duration, dose and results and rationale for why an alternative drug listed on the plan formulary cannot be used
  • Substantial scientific evidence for the requested use supporting the clinical effectiveness of the drug
  • Risk assessment of serious harm to the member’s life, health or recovery without the drug
  • Relevant clinical measures and laboratory results supporting the request
  • Clinical outcome measures to determine when the drug should be stopped or continued
 

Pharmacy Claims

Drugs covered under special authorization are subject to the pricing and claim submission policies, including the Designated High Cost Drugs policy.