Assessment and Prescribing for Cold Sores (Herpes Labialis) by Pharmacists

The assessment and prescribing for cold sores (herpes labialis) 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 one (1) cold sore assessment 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.

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

Patient

• The patient presents with herpes labialis or early (prodromal) signs of herpes labialis.
• The patient has previously been diagnosed with herpes labialis by a physician or nurse practitioner.
• The patient is 12 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 one (1) herpes labialis assessment 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 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 drug therapy for the treatment of herpes labialis must be listed as a benefit on the NB Drug Plans formulary.
• The prescription may be written for a maximum of six treatment courses, for use within a one-year-period.

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 herpes labialis assessment fees 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
• 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. 

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

Table 2

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