Government of New Brunswick

Assessment and Prescribing for Lyme Disease Prophylaxis by Pharmacists

The assessment and prescribing for Lyme disease prophylaxis 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 two (2) Lyme disease prophylaxis assessments per one-year period.

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

Eligibility


Assessment for post-exposure Lyme disease prophylaxis, with or without prescribing, may be eligible for coverage provided all the following criteria are met:

Patient

  • The patient presents within 72 hours of tick removal. 
  • The patient is asymptomatic.
  • The patient must have a valid Medicare card and not reside in a nursing home or a correctional facility.
  • A maximum of two (2) Lyme disease prophylaxis assessment PINs 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 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

  • Pharmacists may prescribe for asymptomatic patients with a tick bite ONLY if:
    • the tick bite was likely acquired in an area of moderate or high risk according to the New Brunswick Department of Health Lyme Disease Estimated Risk Map; and
    • the prophylaxis can be given within 72 hours of tick removal; and
    • the tick is reliably identified as an Ixodes spp. (nymphal or adult female blacklegged) tick; and
    • the duration of tick attachment is estimated to be at least 36 hours based upon the extent of engorgement or time of exposure; and
    • doxycycline is not contraindicated for the patient for the purposes of Lyme disease prophylaxis.
  • If a drug is prescribed, it must be:
    • a single dose of doxycycline, 200 mg for adults or 4.4 mg/kg for children of any age weighing less than 45 kg; 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. 

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 Lyme disease prophylaxis assessment fees which have been paid for by the Department of Health. The applicable assessment fees are outlined below:

Table 1

Assessment Fee

Lyme disease prophylaxis assessment that results in a prescription

$20

Lyme disease prophylaxis assessment that does not result in a prescription (patient declines prescription prophylaxis)

$20

Lyme disease prophylaxis assessment that does not result in a prescription (prescription prophylaxis is not indicated)

$20

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

$20.00

Table 2

Assessment

PIN

Lyme disease prophylaxis assessment that results in a prescription

990000

Lyme disease prophylaxis assessment that does not result in a prescription (patient declines prescription prophylaxis)

990001

Lyme disease prophylaxis assessment that does not result in a prescription (prescription prophylaxis is not indicated)

990002

Pharmacy Audits


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