Government of New Brunswick

Eligibility / Requirements for Enrolment 

Drug Plan Details

Cost to Members (Premiums and Copayments)

Overdue Premiums

Eligibility / Requirements for Enrolment

 

The New Brunswick Drug Plan is available to New Brunswick residents who have an active Medicare card and meet one of the following criteria:

  • Do not have existing drug coverage through a private plan or other government program, or
  • Have existing drug coverage with a private plan, however:

    - They have reached the annual or lifetime maximum for drug coverage with the private plan, or
    - They have been prescribed a drug that is not listed on their private plan formulary for the condition (indication) prescribed.*

*Prior to applying, contact the New Brunswick Drug Plan Information Line toll free at 1-855-540-7325 to confirm that the requested drug is included in the New Brunswick Drug Plan Formulary.

If you have no existing drug coverage

Print and complete an application form and mail or fax it to the address provided on the form. If you would like a form mailed to you, call us toll free at 1-855-540-7325.

If you have existing drug coverage

Print and complete the forms outlined below and mail or fax them, along with the additional information required, to the address provided on the form. If you would like a form mailed to you, call us toll free at 1-855-540-7325.

Enrolment information required for those with existing drug coverage:

  • Completed Application Form
  • Completed Supporting Application Form for those with Existing Drug Coverage
  • A letter from your private plan confirming that:

    - The drug you have been prescribed is not listed on the private plan’s formulary for the condition (indication) prescribed, or
    - You have reached the annual or lifetime drug maximum with the private plan.

  • A completed special authorization request (if applicable).

If you are requesting coverage for more than one drug that is not covered by your private plan, you must submit a letter from your private plan for each drug requested.

The New Brunswick Drug Plan will not consider requests for coverage because you do not meet your private plan’s reimbursement criteria for the condition (indication) prescribed.

In all instances, the New Brunswick Drug Plan is a payor of last resort and coordination with other drug coverage is not permitted. This means, the New Brunswick Drug Plan will only consider coverage for drugs listed on the New Brunswick Drug Plan Formulary when those drugs are not listed on the private plan formulary for the condition (indication) prescribed or are no longer reimbursable because a private plan annual or lifetime maximum has been reached.

 

No, those covered by the NBPDP do not need to join the New Brunswick Drug Plan. The NBPDP is a provincially-funded program that provides drug coverage to eligible beneficiaries, such as, seniors aged 65 and older who receive the Guaranteed Income Supplement, seniors who qualify, residents of nursing homes, clients of the Department of Social Development, and others with certain medical conditions. 

The New Brunswick Drug Plan is a prescription drug insurance plan that provides drug coverage for uninsured New Brunswickers.

 

The New Brunswick Drug Plan offers coverage regardless of pre-existing conditions.

 

No. However, your spouse’s information is required on the application form even if your spouse is not applying for coverage. In the case of a couple (with or without children) in which only one spouse is requesting coverage, the premiums and maximum copayments are calculated based on the annual family income.

 

Eligible dependants include:

  • all dependent children under the age of 19
  • all dependants age 19 or older who are eligible for a Disability Tax Credit under the federal Income Tax Act, AND were eligible for the tax credit as a minor, AND reside with the applicant.

 

If  your family circumstances have changed you must notify the New Brunswick Drug Plan. To add or remove family members to the plan, please fill out the following form:

 

If there are changes to your personal or payment information, please fill out the following form:

 

Yes. You can withdraw your application and cancel your membership at any time by calling 1-855-540-7325.

 

Drug Plan Details

 

No plan in Canada covers every drug on the market. The plan covers approved drugs that are currently on the New Brunswick Drug Plans Formulary which adheres to a national evidenced-based drug review process currently used by public drug plans across Canada.

 

Yes. The plan covers thousands of drugs that have undergone a standard national, evidence-based review and have been recommended to be added to the New Brunswick Drug Plans Formulary. Certain drugs eligible for coverage with the New Brunswick Drug Plan require a special authorization. Drugs listed as special authorization benefits have specific criteria that must be met before they are approved for reimbursement. The criteria are developed by the expert advisory committees based on the evidence considered in the Drug Review Process.

 

No, when generic products are available for a brand name drug, the New Brunswick Drug Plan will only reimburse pharmacies for the lowest cost generic product. Members who choose to receive a brand name product when a generic product exists are responsible for paying any difference in price.

The New Brunswick Drug Plan will consider requests for reimbursement of brand name drugs when a member has had a hypersensitivity reaction (e.g. edema, respiratory distress, serum sickness, anaphylaxis) to a non-medicinal ingredient contained in the generic product. Requests may be made by submitting a completed Special Authorization Request Form and providing details of the hypersensitivity reaction.

Information on the safety and effectiveness of generic drugs is available on Health Canada’s website.

 

The New Brunswick Drug Plan covers drugs listed on the New Brunswick Drug Plans Formulary which covers more than 5,000 drugs including many high cost drugs. No plan in Canada covers every drug on the market. The plan will cover approved drugs which have undergone a national evidenced-based drug review process currently used by public drug plans across Canada. On an ongoing basis, drugs will be added to the Formulary following the same standard process.

Drugs not listed on the Formulary may be requested in certain circumstances; however, the drug requested must be authorized for sale and use by Health Canada.

 

The New Brunswick Drug Plan covers prescription drugs only. Vaccines, medical devices, supplies and equipment (e.g. diabetic supplies, ostomy supplies, oxygen, etc.) are not eligible benefits under the New Brunswick Drug Plan formulary. Some private insurers offer extended health benefits that cover these products.

 

No, these products are not eligible benefits under the New Brunswick Drug Plan formulary

Prescription drugs covered under the plan are selected using a national evidenced-based Drug Review Process. As such, they must first be approved by Health Canada, which issues a Notice of Compliance (NOC) and/or a Drug Identification Number (DIN) to the product, if the drug’s safety efficacy is established by scientific evidence. Health Canada has determined that while there are some potential benefits, current scientific evidence does not establish the safety and efficacy of cannabis to the extent required by the Food and Drug Regulations for marketed drugs in Canada.

For more information on cannabis for medical purposes, please consult Health Canada’s website at: https://www.canada.ca/en/health-canada/topics/cannabis-for-medical-purposes.html

 

Cost to Members (Premiums and Copayments)

 

The premium and copayment amounts are outlined in the table below. The premiums and maximum copayments are calculated based on the annual family income, as indicated by Canada Revenue Agency (CRA) tax return for the tax year immediately preceding the current tax year. All adult plan members pay monthly premiums to be part of the plan. Children 18 and younger will not pay premiums but a parent must be enroled in the plan. All plan members must pay a 30% copayment up to a maximum amount per prescription.

Please visit the premium page for more details.
 

Gross Income Levels Annual
Premium
(per adult)
Monthly
Premium
(per adult)
30% Copay to a Maximum per Prescription
Individual Single with children / Couple with or without children
$17,884 or less $26,826 or less $  200 $  16.67 $5
$17,885 to $22,346  $26,827 to $33,519   $  400 $  33.33 $10
$22,347 to $26,360 $33,520 to $49,389 $  800 $  66.67 $15
$26,361 to $50,000 $49,390 to $75,000 $1,400 $ 116.67 $20
$50,001 to $75,000  $75,001 to $100,000 $1,600 $ 133.33 $25
Over $75,000 Over $100,000 $2,000 $ 166.67 $30

 

Because the premiums are based on ability to pay, people in family situations will have their premium determined based on their family income. If only one adult enrols in the plan, then only one premium must be paid. If two adults in the family enrol in the plan, then two premiums of the same amount must be paid. Children 18 and younger will not pay premiums, but at least one parent must enrol and pay a premium in order for one or more children to be covered.

 

The New Brunswick Drug Plan uses “Total Income” as calculated on line 150 of your Income Tax Return, less any elected split-pension amount on line 116 (if applicable). The CRA determines which sources of income must be included in the amount reported on line 150.

 

Yes. You can request a reassessment through the year, except during the annual reassessment period of July 1st to September 30th.

The NB Drug Plan does not reimburse or charge members for differences between monthly premiums before and after in-year reassessments.

 

If you do not file tax returns with the CRA, you will be charged the maximum annual premium of $2,000 per adult ($166.67 per month). Since premiums are calculated based on family income, which is verified with the CRA annually, it is important to file tax returns each year in order to pay the premium that aligns with your most recent annual family income.

 

New Brunswick Drug Plan premiums and drug copayments are considered eligible medical expenses and can be claimed on line 330 or line 331 of Schedule 1, Federal Tax, of your income tax return. For further information, please contact the CRA at 1-800-959-8281 or visit their website.

Tax receipts for the previous year will be distributed by the New Brunswick Drug Plan before the end of February.

 

Overdue Premiums

 

If your premium payment is not received each month in full, benefits will not be provided and coverage will be suspended or cancelled.

 

If your coverage is suspended, you will not receive drug benefits until your account is paid in full. This means your prescription drugs will not be paid at the pharmacy. An official notice of suspension will be sent in the mail.

You will have 30 days from the date your coverage is suspended to pay the amount owing by cheque or money order. If after 30 days, payment has not been received, your coverage will be cancelled.  

You and your spouse will still be responsible to pay the amount owing, and collection efforts will be made to recover these overdue premiums.

 

If your coverage is cancelled, you will not receive drug benefits (your prescription drugs will not be paid at the pharmacy). You and your spouse are still required to pay the outstanding amount owing, and collection efforts will be made to recover these amounts. Failure to pay amounts owing could have escalating legal consequences.

Members who have had their accounts cancelled due to non-payment of premiums may be subject to a re-instatement fee and waiting period should they choose to re-enrol in the New Brunswick Drug Plan at a later date.

 

You can pay your overdue premiums by sending a cheque or money order to the address below. Please include your New Brunswick Drug Plan ID Number with your payment.

    New Brunswick Drug Plan
    PO Box 690
    Moncton, NB  E1C 8M7

 

You must complete the following steps:

  1. You must complete an application form to re-enrol;
  2. You may have to pay a re-instatement fee; and
  3. A three-month waiting period may apply before your coverage is effective.