Government of New Brunswick

Assessment and Prescribing for Gastroesophageal Reflux Disease (GERD) by Pharmacists

Overview


The assessment and prescribing for gastroesophageal reflux disease (GERD) by a pharmacist may be eligible for coverage by the Department of Health effective May 15, 2023. Each patient is eligible for a maximum of three (3) GERD assessments per one-year period.

This program does not cover drugs, or the costs associated with dispensing or administering drugs.

The assessment and prescribing service is not eligible if the patient qualifies for a prescription renewal service under the Prescription Renewals by Pharmacists program.

Eligibility


Assessment of GERD, with or without prescribing, may be eligible for coverage provided all the following criteria are met:

Patient

  • The patient presents with symptoms consistent with a diagnosis of GERD.
  • The patient does not present within 90 days of a previous episode.
  • The patient is 18 years of age or older.
  • The patient must have a valid Medicare card and not reside in a nursing home or a correctional facility.
  • A maximum of three (3) GERD assessment services per patient within the past 12 months.

Pharmacist

  • The service is conducted in person 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.  
  • 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 Schedule 1 drug is prescribed, 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.
  • If an over-the-counter (OTC) product is prescribed, it must be:
    • approved by Health Canada for gastroesophageal reflux disease; and
    • provided to the patient with specific dosing instructions.
  • If OTC products are provided to the patient without documented specific instructions for use, the assessment fee is not eligible.
  • If the patient requires a proton pump inhibitor, the prescription may be written for a maximum of eight weeks.

Eligible Services and Fees


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 services which have been paid for by the Department of Health. The applicable assessment fees are outlined below:

Table 1

Assessment

 PIN

Fee

GERD assessment that results in a prescription

00980000

 $20

GERD assessment that results in OTC product recommendation

00980001

 $20

GERD assessment that results in both a prescription and OTC product recommendation

00980002

 $20

GERD assessment that does not result in a prescription or OTC product      recommendation

00980003

 $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
  • Patient assessment
  • Treatment plan, including:
    • Prescription(s)
    • Specific instructions for use for over-the-counter products
  • Follow-up plan
  • Referral
  • 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

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

M

Client ID

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

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

Refer to Table 1

Quantity

1

Days Supply

1

Drug Cost / Product Value

Zero

Cost Upcharge

Zero

Professional Fee

$20.00

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:

  • Assessments resulting in the following therapies:
    • Over-the-counter products provided to the patient without documented specific instructions for use.
    • Over-the-counter products not approved by Health Canada for the treatment of gastroesophageal reflux disease.