Government of New Brunswick

Compounded Ophthalmic Drops

This policy outlines the compounded ophthalmic drops that are eligible benefits, the claim submission, and payments requirements.

 

Eligible Compounded Ophthalmic Drops


Compounded ophthalmic drops for topical administration are eligible benefits if they contain the drugs and diluents listed below.

Eligible drugs

  • Regular benefits listed below: The DIN of the drug used in the compound must be listed on the NB Drug Plans Formulary.
  • Special authorization benefits listed below: Approval is required for drugs listed as special authorization benefits.
  • Drugs not listed: If the DIN of the drug used in the compound is not listed on the NB Drug Plans Formulary, a special authorization request must be submitted.

Eligible format size

  • The drug cost paid will be based on the format sizes listed below. Other format sizes require special authorization.

Drug

Format Size
   Regular Benefits

Amphotericin B injection

          50 mg vial

Cefazolin injection

  500 mg, 1 g vial

Ceftazidime injection

        1 g vial

Tobramycin injection 

           80 mg vial

Vancomycin injection

         500 mg vial

Voriconazole injection

         200 mg vial
   Special Authorization Benefits

Cyclosporine injection

   50 mg ampoule

Fluorouracil (5-FU) injection

         500 mg vial

Mitomycin injection

           20 mg vial

Eligible diluents / other ingredients

  • Lubricating eye drops
    • Hypromellose (hydroxypropyl methylcellulose) 0.5%, 1 % (e.g., Alcon Tears)
    • Polyvinyl alcohol 1.4% (e.g., Tears Plus)
  • Sterile normal saline
  • Sterile water
  • Base for compounding fortified ophthalmic drops (e.g., tobramycin ophthalmic drops 0.3%)

Ineligible Compounded Ophthalmic Drops


A compounded ophthalmic drop is not an eligible benefit if any of the following apply:

  • Not for topical administration (e.g., intravitreal, subconjunctival)
  • An alternative is commercially available
  • Duplicates a commercially available product
  • The formula is a proprietary recipe with an undisclosed ingredient list
  • Contains more than one drug
  • Contains a drug or product listed as an exclusion on the NB Drug Plans Formulary
  • Contains any of the following drugs:
    • Acetylcysteine for all indications
    • Atropine for myopia
    • Cyclosporine for dry eyes
    • Naltrexone for all indications
    • Pilocarpine for presbyopia

Claim Submissions


Participating providers must submit claims electronically. Receipts submitted for payment by Plan members will not be accepted.

Information on NB Drug Plans Claim Submissions is online. The fields applicable to compounded ophthalmic drops are listed below.

Field

Information Required

DIN/PIN

Drug Identification Number of the main ingredient in the compound

Quantity

Quantity dispensed

Unlisted Compound Code

7 = compounded eye/ear drop



Drug Cost / Product Value

Total cost of drug, diluents, supplies (see Table 1)

If only a portion of a drug ampoule or vial is used in the compound and the remainder must be discarded, the cost of the whole ampoule or vial may be claimed.

Cost Upcharge

Zero

Dispensing Fee

up to $16.50
Table 1 – Eligible items and Cost Base

Component

Items

Eligible

Cost base

Mark-up

 


Drug

 


Drug Cost

Yes

Must be listed in the NB Drug Plans Formulary or have SA approval

 

up to MLP / MAP

 

up to 8% mark-up

 

 

 

 


Supplies applicable to a particular prescription

Diluent

Yes








AAC

 








-

 

Syringes

Yes

Needles

Yes

 

Syringe filters

Yes

If formula specifies a filter is required

Sterile surgical gloves


Yes

Other supplies (e.g., disinfectant wipes, alcohol swabs)

 

No



-



-

Pharmacy Provider Audits

 

All claims submitted to the NB Drug Plans for payment are subject to audit and recovery.