Government of New Brunswick

Assessment and Prescribing for Seasonal Influenza Prophylaxis by Pharmacists

 

Overview


The assessment and prescribing for seasonal influenza prophylaxis by a pharmacist for qualifying residents of New Brunswick adult residential facilities (ARFs) may be eligible for coverage by the Department of Health effective September 25, 2023.

Qualifying residents are those who reside in Level 3 Generalist Care and Memory Care Homes. A list of eligible ARFs is available here.

Each patient is eligible for a maximum of three (3) assessments per one-year period.

If the assessment results in a prescription for oseltamivir, information on how to submit a claim is available on the Seasonal Influenza Drug Therapy for Residents of Adult Residential Facilities web page.

 

 

Eligibility


Assessment for seasonal influenza prophylaxis, with or without prescribing, may be eligible for coverage provided the following criteria are met:

Patient

  • The patient is 19 years of age or older.
  • The patient resides in an ARF in New Brunswick, or is a relief bed program participant. A list of eligible ARFs is available here.
  • An influenza outbreak has been declared by the Regional Medical Officer of Health (RMOH), and antiviral prophylaxis has been recommended for the facility. 
  • The patient is asymptomatic for influenza-like illness.
  • There is no active standing order prescription for oseltamivir prophylaxis from the patient’s primary care provider.
  • A maximum of three (3) Seasonal Influenza Prophylaxis assessment PINs per patient within the past 12 months.

 

Pharmacist

  • The pharmacist has been notified that an outbreak of seasonal influenza has been declared in the facility, and influenza antiviral prophylaxis has been recommended by the RMOH.
  • The service may be conducted by a pharmacist licensed with the NB College of Pharmacists (NBCP).
  • The pharmacist must comply with all applicable NBCP requirements and standards.
  • The pharmacist must obtain consent from the patient, legal guardian, or substitute decision maker for the service being provided. 
  • If the service is provided virtually, the pharmacist must be physically present at the participating provider pharmacy location while conducting the service.
  • The pharmacist must document a follow-up plan that is sufficiently detailed to monitor the patient's progress and ensure continuity of care. 
  • When prescribing a drug, the pharmacist will notify the patient’s physician or nurse practitioner when one exists. If one does not exist, the pharmacist will provide the patient with a copy of this notification.

 

Prescription

  • If a drug is prescribed, it must be oseltamivir; and,
    • dispensed on the same day as the assessment is submitted for payment; and
    • dispensed from the pharmacy submitting the assessment, unless the patient chooses to fill the prescription at another pharmacy, however this must be documented on the assessment and prescribing tool.   
 

Eligible Fees and Services


The Department of Health will pay participating providers for each claim billed for eligible patients in New Brunswick. The participating provider is not permitted to charge additional fees to the patient or the facility for assessment fees which have been paid for by the Department of Health. The applicable assessment definitions and fees are outlined below:

Table 1

Assessment

PIN

 Fee  

Assessment that results in a prescription for prophylaxis

905000

$20

Assessment that does not result in a prescription for prophylaxis

905001

$20
 

Documentation Requirements


Pharmacists must document how the patient meets the eligibility criteria for this policy and use an appropriate assessment and prescribing tool.

The assessment and prescribing tool must be used to document the following (as applicable):

  • Patient, legal guardian, or substitute decision maker consent
  • In-person or virtual assessment
  • Patient assessment
  • Treatment plan, including:
    • Prescription(s)
    • Specific instructions for use for over-the-counter products
  • Follow-up plan
  • Referral and notification of the patient’s physician or nurse practitioner when one exists. If one does not exist, the pharmacist will document that they have provided the patient with a copy of this notification.
  • Completed follow-up information
 

Claim Submission


Pharmacists must document how the eligibility criteria are met for the Assessment and Prescribing for Seasonal Influenza Prophylaxis by Pharmacists for each patient.

Manual claims will not be accepted. Claims must be submitted online and include the following information:

Field

Information Required

Carrier ID

NB

Group Number or Code

I

Client ID

Patient’s NB Medicare number, if available.  (Note: this also applies to New Brunswick Drug Plans beneficiaries.)

Enter “999999999” for individuals who do not have a NB Medicare number.

Note: If there is a requirement for a pharmacy to submit more than one claim on the same day for the same DIN under this pseudo Medicare number, subsequent claims must be submitted with Intervention Code “MG”.

Patient Code

Leave Blank

Patient Name

Patient’s first and last name

Patient DOB

Patient’s date of birth

Prescriber ID

New Brunswick College of Pharmacists Licence Number of the prescribing pharmacist.

Prescriber ID Reference Code

46

DIN / PIN

Please refer to Table 1

Quantity

1

Days Supply

1

Drug Cost / Product Value

Zero

Cost Upcharge

Zero

Professional Fee

$20

Intervention and Exception Code

CPhA codes if required
 

Pharmacy Audits


All claims submitted by participating providers for reimbursement are subject to audit and recovery.

 

Service Exclusions


Claims for service fees for providing the following types of assessment services are excluded:

  • Assessment and prescribing of oseltamivir for:
    • the treatment of influenza,
    • patients who do not reside in an ARF listed here, or
    • patients who have an active standing order prescription for oseltamivir.