The New Brunswick Drug Plans are payer of last resort, which means that all other drug coverage options must be used before applying for coverage. This includes coverage through a private drug plan (including an appeal or exception process), a Health Spending Account (HSA) and a drug manufacturer’s Patient Support Program.
Individuals who have other drug coverage may apply to the New Brunswick Drug Plans if they:
- have reached the annual or lifetime maximum for drug coverage with their private plan, or
- have been prescribed a drug that is not listed on their private plan formulary for the condition (indication) being treated, and
- have pursued all other drug coverage options.
Applicants should contact the New Brunswick Drug Plans information line at 1-800-332-3692 to confirm that the drug prescribed is included on the New Brunswick Drug Plans Formulary.
The following documentation must be submitted annually:
- Completed application form for the drug plan the applicant is seeking to enrol in.
- Completed Other Drug Coverage form.
- Letter from the applicant’s private plan(s) that includes the following information:
a. Confirmation that they have reached the annual or lifetime maximum for drug coverage with their private plan, or
b. Confirmation that the drug they have been prescribed is not listed on the private plan’s formulary for the condition being treated, and
c. Confirmation that they have been denied an exception or appeal for coverage of the drug from the private plan.
- If a drug is listed as a special authorization benefit, the applicant’s health care provider must submit a special authorization request before the application can be processed.
Notification of Changes
If there are changes in the member’s other drug coverage at any time during the year, they must notify the NB Drug Plans. Depending on the change, the member may be required to submit a new Other Drug Coverage form along with the supporting documentation.