Government of New Brunswick

General Plan Information

Drug Plan Details

Cost to Members (Premiums and Copayments)

Overdue Premiums

General Plan Information

The New Brunswick Drug Plan is a prescription drug insurance plan that provides drug coverage for uninsured New Brunswickers. The plan covers drugs listed on the New Brunswick Drug Plan formulary.  

 

The New Brunswick Drug Plan began on May 1, 2014. Uninsured New Brunswickers with a valid Medicare card can choose to enrol in the plan. 

 

Uninsured New Brunswickers with a valid Medicare card are eligible for the plan. Some insured New Brunswickers are also able to join the plan, as long as they meet one of the following eligibility criteria:

  • have reached their maximum for drug coverage under their existing drug plan
  • have been prescribed a specific drug that is not covered under their existing drug plan, but is covered under the New Brunswick Drug Plan.

To enrol please visit the enrol page to print an application form or call 1-855-540-7325.
 

Individuals and families will have the peace of mind of knowing that they have access to prescription drugs now and in the future.

The plan benefits New Brunswickers who:

  • Can’t afford one very expensive drug – The drug plan covers some very expensive drugs such as Remicade.
  • Can’t afford a number of lower cost drugs, often to manage a chronic disease – The drug plan offers coverage for thousands of drugs with no maximum limits on coverage.
  • Are self-employed or retired and don’t have insurance – The drug plan offers coverage to every uninsured New Brunswicker, regardless of income or their employment situation.
  • Have difficulty getting private drug coverage because of pre-existing medical conditions – The drug plan offers coverage regardless of pre-existing conditions
  • Have private drug coverage but their plan does not cover one or more drugs that are on the New Brunswick Drug Plan Formulary – New Brunswickers may keep their private drug plans through their workplace and join the New Brunswick Drug Plan if they need one or more drugs that are covered under the New Brunswick Drug Plan but not by their private plan, as long as they meet the eligibility criteria.
  • Have private drug coverage but they have reached their annual or lifetime cap on benefits - New Brunswickers may keep their private drug plans through their workplace and join the New Brunswick Drug Plan if they need a drug that is covered under the New Brunswick Drug Plan but not by their private plan due to having reached their cap on benefits, as long as they meet the eligibility criteria.
  • Have mandatory private drug coverage through their workplace – Individuals may enrol but there will be no coordination of benefits. The New Brunswick Drug Plan covers only the drugs on the formulary not covered by an individual’s private workplace plan or costs for drugs on the formulary once an individual’s annual or lifetime cap has been reached.
  • Would like to retire but are unable to because they can’t afford to lose the drug coverage provided by their employer – The New Brunswick Drug Plan provides individuals who are retiring with an option for drug coverage. 

Having access to the prescription drugs that are necessary to treat medical conditions and improve quality of life is a huge benefit.

The plan will help:

  • Ensure continuity of care from the hospital to outpatient and community setting;
  • Reduce visits to hospital emergency rooms, and frequency and duration of hospitalizations;
  • Improve patient outcomes and quality of life;
  • Provide better opportunities and remove financial barriers to drug coverage for people who are moving from social assistance to employment; and
  • Enable New Brunswickers to work their way out of poverty and prevent residents from experiencing financial hardship or falling into poverty due to high drug costs. 
     

The plan’s costs will be covered by plan members, through premiums and payments (copayments) at the pharmacy, and government. 

 

No, those covered by the NBPDP do not need to join the New Brunswick Drug Plan. The New Brunswick Prescription Drug Program is a provincially-funded program that provides drug coverage to eligible beneficiaries, such as, seniors aged 65 and older who receive the Guaranteed Income Supplement, seniors who qualify through an income test, residents of nursing homes, clients of the Department of Social Development, and others with certain medical conditions. 

The New Brunswick Drug Plan is a prescription drug insurance plan that provides drug coverage for uninsured New Brunswickers. 

 

Drug Plan Details

No plan in Canada covers every drug on the market. The plan covers approved drugs that are currently on the New Brunswick Drug Plan formulary which adheres to a national evidenced-based drug review process currently used by public drug plans across Canada.

 

Yes. The plan covers thousands of drugs that have undergone a standard national, evidence-based review and have been recommended to be added to the formulary, some of which are very expensive such as Soliris and Remicade.

 

No, when generic products are available for a brand name drug, the New Brunswick Drug Plan will only reimburse pharmacies for the lowest cost generic product. Members who choose to receive a brand name product when a generic product exists are responsible for paying any difference in price.

The New Brunswick Drug Plan will consider requests for reimbursement of brand name drugs when a member 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.

 

The New Brunswick Drug Plan covers drugs listed on the New Brunswick Drug Plan formulary which covers more than 5,000 drug products including many high cost drugs.

 

The New Brunswick Drug Plan covers drugs listed on the New Brunswick Drug Plan formulary which covers more than 5,000 drugs including many high cost drugs. No plan in Canada covers every drug on the market. The plan will cover approved drugs which have undergone a national evidenced-based drug review process currently used by public drug plans across Canada. On an ongoing basis, drugs will be added to the formulary following the same standard process.

Drugs not listed on the formulary may be requested in certain circumstances; however, the drug requested must be authorized for sale and use by Health Canada.

 

The New Brunswick Drug Plan covers prescription drugs only. Vaccines, medical devices, supplies and equipment (e.g. diabetic supplies, ostomy supplies, oxygen, etc.) are not eligible benefits under the New Brunswick Drug Plan formulary. Some private insurers offer extended health benefits that cover these products.

 

The New Brunswick Drug Plan Formulary is available here.

 

Once members are enrolled in the plan they will receive an identification card that they must show at the pharmacy when filling a prescription.

 

Cost to Members (Premiums and Copayments)

The premium and copayment amounts, effective April 1, 2015, are outlined in the table below:

 

 

Gross Income Levels Annual
Premium
(per adult)
Monthly
Premium
(per adult)
30% Copay to a Maximum per Prescription
Individual Single with Children / Couple with or without children
$17,884 or less $26,826 or less $  200 $  16.67 $5
$17,885 to $22,346  $26,827 to $33,519   $  400 $  33.33 $10
$22,347 to $26,360 $33,520 to $49,389 $  800 $  66.67 $15
$26,361 to $50,000 $49,390 to $75,000 $1,400 $ 116.67 $20
$50,001 to $75,000  $75,001 to $100,000 $1,600 $ 133.33 $25
Over $75,000 Over $100,000 $2,000 $ 166.67 $30

The premiums and maximum copayments are calculated based on the annual family income, as indicated by Canada Revenue Agency tax return for the year immediately preceding the current year. All adult plan members pay monthly premiums to be part of the plan. Children 18 and younger will not pay premiums but a parent must be enroled in the plan. All plan members must pay a 30% copayment up to a maximum amount per prescription.

Please visit the premium page for more details.  

 

Because the premiums are based on ability to pay, people in family situations will have their premium determined based on their family income. If only one adult enrols in the plan, then only one premium must be paid. If two adults in the family enrol in the plan, then two premiums of the same amount must be paid. Children 18 and younger will not pay premiums, but at least one parent must enrol and pay a premium in order for one or more children to be covered.

 

Yes, as the plan is voluntary and premiums are based on income.

 

The New Brunswick Drug Plan uses “Total Income” as calculated on Line 150 of your Income Tax Return. The Canada Revenue Agency (CRA) determines which sources of income must be included in the amount reported on Line 150. The NB Drug Plan will use the amount on Line 150 as Total Income, less any elected split-pension amount on Line 116 (if applicable).

 

Program premiums and drug copayments are considered eligible medical expenses for taxation purposes. For further information, please contact Canada Revenue Agency at 1-800-959-8281.

Tax receipts for the previous year will be distributed by the end of February.

 

Overdue Premiums

You are required to pay your premiums.  If payment is not received, your drug coverage will be suspended.

 

If your coverage is suspended, you will not receive drug benefits (your prescription drugs will not be paid at the pharmacy), until your account is paid in full.  An official notice of suspension will be sent in the mail.

You will have 30 days from the date your coverage is suspended in which to pay the amount owing by way of cheque or money order, and include your New Brunswick Drug Plan ID Number with payment. The mailing address is noted here. If after 30 days, payment has not been received, your coverage will be cancelled.  

You and your spouse will still be responsible to pay the amount owing, and collection efforts will be made to recover these overdue premiums.

 

If your coverage is cancelled, you will not receive drug benefits (your prescription drugs will not be paid at the pharmacy). You and your spouse are still required to pay the outstanding amount owing, and collection efforts will be made to recover these amounts. Failure to pay amounts owing could have escalating legal consequences.

Members who have had their accounts cancelled due to non-payment of premiums may be subject to a re-instatement fee and waiting period should they choose to re-enrol in the New Brunswick Drug Plan at a later date.

 

If your coverage is suspended and you have paid your overdue premiums, drug coverage will continue (your prescription drugs will be paid at the pharmacy). This means that there will be no gap in coverage.

Prescription drug claims that were not paid at the pharmacy while your coverage was suspended can be submitted for processing (the mailing address is noted here).

 

If only one month’s premiums are overdue, an attempt will be made to automatically deduct two months premiums from your bank account (using pre-authorized debit) on the first of the following month.

If your account is suspended or cancelled, payment can be made by cheque or money order (include your New Brunswick Drug Plan ID Number) with your payment to the address below.

    New Brunswick Drug Plan
    PO Box 690
    Moncton, NB  E1C 8M7

 

You must complete the following steps:

  1. All outstanding premiums, that you and your spouse owe, will have to be paid in full; 
  2. You must complete an application form to re-enrol;
  3. You should expect to pay a re-instatement fee; and
  4. A three month waiting period may apply before your coverage is effective.