Assessment and Prescribing for Paxlovid by Pharmacists

The assessment and prescribing for nirmatrelvir/ritonavir (Paxlovid) by a pharmacist is eligible for coverage by the Department of Health effective September 22, 2022. Each patient is eligible for a maximum of three (3) assessments per one-year period.

If the assessment results in a prescription for nirmatrelvir/ritonavir (Paxlovid), this program does not cover the cost associated with dispensing nirmatrelvir/ritonavir (Paxlovid).

Pharmacists are encouraged to add their names to the list of NB pharmacies offering this service by contacting New Brunswick Drug Plans via email at [email protected]. Alternatively, pharmacists can call New Brunswick Drug Plans at 1-800-332-3691.
 

Assessment for nirmatrelvir/ritonavir (Paxlovid) treatment, with or without prescribing, may be eligible for coverage provided the following criteria are met:

Patient

• The patient is aged 18 and older.
• The patient presents with COVID symptoms, with symptom onset occurring within the past 5 days.
• The patient presents with a positive COVID PCR test (laboratory confirmed test), POCT test (rapid antigen test) or Abbott ID test. The patient’s verbal confirmation of the test type, result, and date is sufficient.
• The patient does not need a valid Medicare card.
• A maximum of three (3) Paxlovid assessment PINs of any combination per patient within the past 12 months.

Pharmacist

• The service is conducted preferably virtually or via telephone, or in person if needed, 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 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

Any of the following:

• The pharmacist prescribes nirmatrelvir/ritonavir (Paxlovid) DIN 02524031 or DIN 02527804.
• A prescription for nirmatrelvir/ritonavir (Paxlovid) received from another prescriber is adapted by the pharmacist due to an inappropriate dose.

When a prescription for nirmatrelvir/ritonavir (Paxlovid) is dispensed, it must be:

• 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.

 
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 for a nirmatrelvir/ritonavir (Paxlovid) assessment that has been paid by the Department of Health. The applicable assessment fees are outlined below:

Table 1

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, substitute decision maker consent
• 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.
   

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

Table 2

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

Claims for assessment fees for the following services are excluded:

• Dispensing a prescription of nirmatrelvir/ritonavir (Paxlovid) written from another prescriber and no adjustments to the prescription are required.
• Refusing to fill a nirmatrelvir/ritonavir (Paxlovid) prescription written by another prescriber.