This policy applies to the NB Drug Plans (New Brunswick Prescription Drug Program and New Brunswick Drug Plan).
Methadone for the Treatment of Opioid Use Disorder
Requests for coverage of methadone for the treatment of opioid use disorder will be considered under special authorization for patients who are not taking other opioids.
For Social Development clients, a Consent for Restricted Prescription Services form identifying their choice of prescriber(s) and pharmacy(ies) must be completed and submitted.
- Methadone products that are eligible benefits are listed in the NB Drug Plans Formulary.
- A maximum daily dose of 200mg will be reimbursed for methadone. Doses greater than 200mg have been associated with significant adverse effects. This is enforced through limits set in the electronic adjudication system. Exceptions may be considered with evidence of altered metabolism as demonstrated by serum peak/trough results.
Methadone patients will be restricted to one pharmacy providing methadone, as outlined in the Methadone Practice Directive of the New Brunswick College of Pharmacists, except when the primary pharmacy is located in an area where 7 day service is not available and where the client does not meet the criteria for take-home doses (carries).
A second pharmacy may be authorized to be reimbursed for methadone on days when the primary pharmacy is closed.
- In order to qualify for approval of a second pharmacy, the patient’s primary residence must lie outside the municipal boundary of any community having a 7 day methadone provider.
- A 7 day methadone provider is defined as any licensed pharmacy open for business 365 days per year agreeing to dispense methadone for opioid use disorder on a regular daily basis.
- Prior to involving a second pharmacy, it will be the responsibility of the patient to ascertain the willingness of both pharmacies to participate and to ensure that their methadone provider/clinic is aware of the need to provide methadone prescriptions to both pharmacies.
- For Social Development clients, the second pharmacy must be identified on the Consent for Restricted Prescription Services form.
Take-Home Doses (Carries)
Carries of methadone for the treatment of opioid use disorder will be reimbursed for patients who meet the Methadone Practice Directive criteria for carries. Up to six carries in any 7 day period will be reimbursed.
Information on NB Drug Plans Claim Submissions is available here.
- Claims for eligible benefits must include the applicable DIN /PIN.
- The unit of measure (quantity) for billing compounded methadone oral solution claims is milligrams. For example, a 70mg dose of methadone should be billed as a quantity of 70.
- Electronic billing is to be completed by the pharmacy on a daily basis for patients receiving witnessed and carry doses of methadone. One claim is permitted per day.
- Backdating and resubmission of electronic claims is permitted within 90 days.