This policy applies to all participating providers of the New Brunswick Drug Plans. The New Brunswick Drug Plans include the New Brunswick Prescription Drug Program (NBPDP), New Brunswick Drug Plan and Extra-Mural Program (EMP).
Payment for Parenteral Sterile Preparations
The eligible parenteral sterile preparations are those that contain drugs for infusion in CADD cassettes, IV bags and elastomeric pumps.
All drugs in a sterile preparation must be listed on the NB Drug Plans Formulary (regular benefit or special authorization benefit for which approval has been granted). If a preparation contains a drug (DIN) not listed on the NB Drug Plans Formulary, special authorization is required.
- The pharmacy must submit a worksheet for each type of preparation (drug and quantity) using the NB Drug Plans worksheet template which may be requested by emailing [email protected].
- A worksheet must be approved before a claim for the preparation is submitted. If a worksheet is submitted outside of normal business hours for the NB Drug Plans, every effort will be made to review the worksheet by the end of the next business day.
- The worksheet must include the cost of each eligible item (see Table 1).
- Submit worksheets and invoices for eligible supplies and special packaging to [email protected]. If there is a price change for any approved supplies or special packaging, the applicable worksheets must be resubmitted with the new price and invoice.
- Approved worksheets will be emailed to the pharmacy to confirm that claims may be submitted.
- To minimize wastage, it is expected that every effort will be made to use the most appropriate strength and quantity of drug needed.
- The pharmacy must submit the corresponding prescription record within 5 days of the submission of each claim. The information required in the prescription record is outlined in the Definitions section below.
- If the prescription record is not received within 5 business days, the NB Drug Plans will send the pharmacy (by fax or secure email) the prescription numbers of the prescription records not received. If the prescription record is not received within 5 business days of the date of the email or fax, the claim will be reversed by the NB Drug Plans. This reversal will show as a deduction on a future payment summary.
- Sterile preparation claims and corresponding prescription records will be reviewed to ensure they match the approved worksheet. Overbilled claims will be reversed and resubmitted by the NB Drug Plans. The reversal and resubmission will show on a future payment summary. No action is required by the pharmacy.
- All claims submitted to the NB Drug Plans for payment are subject to audit and recovery.
Claims submitted by participating providers must include the following information:
Field |
Information Required |
Carrier ID |
NB |
Group Number or Code |
Plan Identification Letter (refer to NB Drug Plans Claim Submissions web page) |
Client ID |
Patient’s Plan ID number or Medicare number (refer to NB Drug Plans Claim Submissions web page) |
Patient Code (NB Drug Plan only) |
Patient’s ID number (refer to NB Drug Plans Claim Submissions web page) |
Patient Name |
Patient’s first and last name |
Patient DOB |
Patient’s date of birth |
Prescriber ID |
Prescriber’s license or registration number (refer to NB Drug Plans Claim Submissions web page) |
Prescriber ID Reference Code |
Code identifying a prescriber’s licensing body (refer to NB Drug Plans Claim Submissions web page) |
DIN / PIN |
Drug Identification Number / Product Identification Number |
Quantity |
Quantity dispensed |
Days Supply |
Number of days’ supply dispensed (refer to NB Drug Plans Claim Submissions web page) |
Unlisted Compound Code |
6 = injection or infusion |
Drug Cost / Product Value |
Total cost of:
|
Cost Upcharge |
Zero |
Dispensing Fee |
Up to $16.50 |
Table 1 – Eligible items and Cost Base |
|
|||
Component |
Items |
Eligible |
Cost base |
Mark-up |
Drug |
Drug Cost |
Yes (Must be listed in the NB Drug Plans Formulary or have SA approval) |
up to MLP / MAP |
up to 8% mark-up |
Supplies applicable to a particular prescription |
Diluent |
Yes |
AAC
|
-
|
Syringes |
Yes |
|||
Needles |
Yes |
|||
Needle filters |
Yes |
|||
Repeater pump tube set |
Yes |
|||
Sterile surgical gloves |
Yes |
|||
Other supplies (e.g. disinfectant wipes, alcohol swabs) |
No |
- |
- |
|
Special packaging |
CADD cassette Elastomeric pump |
No (for EMP patients) |
- (Provided by EMP) |
- |
Yes (for non-EMP patients) |
AAC |
- |
||
IV bag |
Yes |
AAC |
- |
|
Sterile garb |
Protective coveralls |
No (Part of sterile prep fee) |
- |
- |
Shoe covers |
||||
Face masks |
||||
Hair nets / Bouffant caps |
||||
Other supplies (e.g. disinfectant wipes, alcohol swabs) |
Table 2 - Sterile Preparation Fees |
|||
Product |
Quantity |
Sterile Preparation Fee |
Dispensing Fee |
CADD cassette |
1 x 100 mL |
up to $34.50 |
Add up to $16.50 |
2 x 100 mL |
up to $44.50 |
||
IV bag |
1 to 2 |
up to $29.50 |
|
3 to 7 |
up to $54.50 |
||
8 or more |
up to $64.50 |
||
Elastomeric pump |
1 to 2 |
up to $19.50 |
|
3 to 7 |
up to $34.50 |
||
8 to 14 |
up to $44.50 |
||
15 or more |
up to $54.50 |
IV Bags or Elastomeric pumps
One drug product (e.g. 21 Cefazolin 1g IV bags)
Field |
Information Required |
DIN / PIN |
Cefazolin 1 g vial (DIN listed in Formulary) |
Quantity |
21 |
Unlisted Compound Code |
6 = injection or infusion |
Drug Cost / Product Value |
Total amount for the following:
|
Cost Upcharge |
Zero |
Dispensing Fee |
Up to $16.50 |
Two drug products/DINs (e.g. 21 Cefazolin 2 g elastomeric pumps)
Field |
Information Required |
DIN / PIN |
Cefazolin 10 g vial (DIN listed in Formulary) or Cefazolin 1 g (DIN listed in Formulary) Note: If one drug requires special authorization, the DIN of this drug must be used. |
Quantity |
21 |
Unlisted Compound Code |
6 = injection or infusion |
Drug Cost / Product Value |
Total amount for the following:
|
Cost Upcharge |
Zero |
Dispensing Fee |
Up to $16.50 |
CADD cassettes
One drug product (e.g. 100 mL Hydromorphone 20 mg/mL CADD cassette)
Field |
Information Required |
DIN / PIN |
Hydromorphone 20mg/mL (DIN listed in Formulary) |
Quantity |
100 |
Unlisted Compound Code |
6 = injection or infusion |
Drug Cost / Product Value |
Total amount for the following:
|
Cost Upcharge |
Zero |
Dispensing Fee |
Up to $16.50 |
The following definitions apply in this policy:
CADD cassette: The reservoir that contains medication that is delivered in a Continuous Ambulatory Deliver Device (CADD) Pump.
Diluent: A liquid that decreases the concentration of a solution or turns powder into a liquid.
Elastomeric pump: A pump that uses pressure to infuse medication.
IV bags: An intravenous (IV) bag is a sterile bag used to hold drugs that are administered to a patient intravenously.
Prescription record: The prescription record includes all information recorded in written and electronic format pertinent to the prescription dispensed. For payment of parenteral sterile preparations, the following information is required:
a) Prescription number
b) Date the prescription was dispensed
c) Name of the patient
d) Patient’s Medicare or drug plan ID number
e) Name of the prescriber
f) Drugs and other ingredients contained in the sterile preparation, including the name, strength, quantity, manufacturer’s name and drug identification number (DIN) or Product Identification Number (PIN) or Natural Product Number (NPN), if applicable
g) Supplies used for the sterile preparation, including the name and quantity
h) Dosage instructions
i) Signature of pharmacist performing final check
Worksheet: A document that specifies the amounts and costs of all the ingredients contained in, and supplies used to prepare, each sterile preparation.