Assessment and Prescribing for Contraception Management by Pharmacists

The assessment and prescribing for hormonal contraception by a pharmacist may be eligible for coverage by the Department of Health effective June 6, 2022. Each patient is eligible for a maximum of three (3) contraception management 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.

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

Patient

• The patient has a menstrual cycle and is not experiencing unusual menstrual changes.
• The patient is not pregnant, breastfeeding or within 6 weeks post-partum.
• The patient is between 12 and 50 years of age.
• The patient must have a valid Medicare card and not reside in a nursing home or a correctional facility.
• A maximum of one (1) contraceptive management initial assessment service per patient within the past 12 months.
• A maximum of one (1) contraceptive management subsequent assessment service resulting in change in prescription per patient within the past 12 months.
• A maximum of one (1) contraceptive management subsequent assessment service that does not result in a change in therapy or results in therapy discontinuation and/or referral per patient within the past 12 months.

Pharmacist

• The service is 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.
• The initial assessment must be conducted in person. However, a virtual subsequent assessment may be eligible for coverage in cases where patients face barriers to attending in-person appointments. This includes, but is not limited to, individuals with disabilities, those requiring caregiver support, or those without access to transportation.
• If the subsequent assessment is provided virtually,
  • it must be conducted as a direct, real-time (synchronous) interaction with the patient (e.g., via audio call, video call), and
  • 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:
  • a Schedule 1 drug; 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.
• The assessment is not eligible if the patient qualifies for a prescription renewal. Exceptions may be granted if the pharmacist makes the clinical decision to perform a contraception management initial assessment and the specific rationale is documented in the assessment and prescribing tool.
• For prescriptions by a pharmacist to maintain a patient's existing therapy, the pharmacist should prescribe for an expected duration of one-year, unless, in the professional judgement of the pharmacist, it would be unsafe or unwise to do so, and the specific rationale is documented in 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 the services which have been paid for 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
• In-person or virtual assessment
  • If virtual care was provided, include:
    • the form of communication (e.g., audio call, video call), and
    • the reason the service was provided virtually.
• 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.

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

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

Claims for service fees for providing the following services are excluded:

• Assessments for the primary purpose of prescribing and/or dispensing emergency contraception, and a full contraception management assessment was not completed.