Government of New Brunswick

The purpose of provider audit is to ensure that the prescription documentation retained by the pharmacy is consistent with the claims billed to the New Brunswick government-sponsored drug plans (“NB Drug Plans”). It is also to verify compliance with the Acts and Regulations (Prescription Drug Payment Act and Regulation and the Prescription and Catastrophic Drug Act and Regulation) and policies of the NB Drug Plans.

All claims are subject to audit. Claims that do not comply with the policies of the NB Drug Plans will be subject to recovery. Claims policies may be accessed at the following links:

Providers may be selected for desk audits and/or on-site audits.

 

Desk Audits

Desk audits involve a review of a sample of claims from a provider. Claims documentation supporting these prescriptions may be requested in writing through a verification letter. Types of verification letters include, but are not limited to, the following:

  • Compound Review verification letters requesting documentation to confirm the ingredients contained in the compound and the actual acquisition cost of each ingredient.
  • Close Proximity verification letters requesting information to confirm the reason prescription claims for the same drug were submitted in close proximity to each other.
  • Frequency of Dispensing verification letters requesting documentation to confirm that the claim meets the requirements of the Frequency of Dispensing and Payment Policy.
  • NB PharmaCheck™ verification letters requesting documentation to confirm that the claim meets the requirements in the NB PharmaCheck™ Policy.
 

On-Site Audits

On-site audits involve a review of a sample of claims a provider has submitted to the NB Drug Plans. Specific details of the audit, including claims to be reviewed, are not provided prior to the on-site visit.

Documentation to support the prescriptions claimed must be available for review during the on-site audit. Only the documentation available at the time of the audit will be considered.

Actual Acquisition Cost (AAC) Verification

Actual Acquisition Cost (AAC) means the cost of a product to the provider, based on reasonable and customary purchasing practices, which is calculated by:

a)     deducting from the total amount paid or payable, exclusive of shipping charges, by the provider to purchase the product, the value of any price reduction,

b)     dividing the result obtained under paragraph (a) by the number of units purchased by the pharmacy or dispensing physician, and

c)     multiplying the unit cost determined under paragraph (b) by the number of units dispensed.

Acceptable Documents for Actual Acquisition Cost (AAC) Verification

  • Manufacturer’s invoices
  • Internal / External Wholesaler invoices
  • Internal / External Wholesaler invoice summaries

Note: Packing Slips, screenshots of internal pharmacy software system and catalogue pages will not be accepted.

Frequency of Dispensing and Payment Policy Verification

  • Frequent Dispensing Authorization forms completed after a pharmacy has been notified of an audit will not be accepted.
  • Details on the policy are outlined here.

NB PharmaCheckTM Verification

  • The patient must leave with a complete, accurate, up-to-date personal medication record that includes the name and signature of both the patient and the pharmacist who conducted the Medication Check-up, as well as the pharmacy contact information. A copy of the signed record must be retained by the pharmacy for a period of three years.
  • Details on the policy are outlined here.