Government of New Brunswick

Assessment and Prescribing for Mild Acne

The assessment and prescribing for mild acne 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) mild acne assessments per one-year period.

This program does not cover the cost associated with the dispensing of drugs.

This program does not apply to prescribing that is eligible as a renewal under the Prescription Renewals by Pharmacists program.

Eligibility


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

Patient

  • The patient presents with a skin condition consistent with a diagnosis of mild acne.
  • The patient does not present with symptoms of other types of dermatoses.
  • The patient is at least 12 years of age and is not older than 30 years of age if new onset of acne.
  • The patient does not have a family history of scarring acne.
  • The patient must have a valid Medicare card and not reside in a nursing home or a correctional facility.
  • A maximum of one (1) mild acne initial assessment PIN per patient within the past 12 months.
  • A maximum of one (1) mild acne subsequent assessment resulting in change in therapy PIN per patient within the past 12 months.
  • A maximum of one (1) mild acne subsequent assessment that does not result in a change in therapy PIN or mild acne subsequent assessment resulting in therapy discontinuation and/or referral PIN 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 written 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 patients 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:
    • a topical product; 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; and
  • If an over-the-counter (OTC) product is prescribed, it must be:
    • a topical product; and
    • approved by Health Canada for mild acne or is widely accepted as best practice in Canada and supported by medical literature demonstrating safety and efficacy for mild acne 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.

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

Table 1

Assessment

Fee

 Mild Acne initial assessment that results in a prescription

$20

 Mild Acne initial assessment that results in OTC product recommendation

$20

 Mild Acne initial assessment that results in both a prescription and OTC product recommendation

$20

Mild Acne initial assessment that does not result in a prescription or OTC product recommendation

$20

 Mild Acne subsequent assessment resulting in change in therapy

$20

Mild Acne subsequent assessment that does not result in a change in therapy

$12

Mild Acne subsequent assessment resulting in therapy discontinuation and/or referral 

$12

 

 

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 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

 

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

Please refer to Table 2

Quantity

1

Days Supply

1

Drug Cost / Product Value

Zero

Cost Upcharge

Zero

Professional Fee

Please refer to Table 1

Table 2

Assessment

PIN

Mild Acne initial assessment that results in a prescription

970000

Mild Acne initial assessment that results in OTC product recommendation

970001

Mild Acne initial assessment that results in both a prescription and OTC product recommendation

970002

Mild Acne initial assessment that does not result in a prescription or OTC product recommendation

970003

Mild Acne subsequent assessment resulting in change in therapy

970004

Mild Acne subsequent assessment that does not result in a change in therapy

970005

Mild Acne subsequent assessment resulting in therapy discontinuation and/or referral 

970006

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 mild acne, or not widely accepted as best practice in Canada and supported by medical literature demonstrating safety and efficacy for mild acne.