Government of New Brunswick

Assessment and Prescribing for Contraception Management by Pharmacists

The assessment and prescribing for hormonal contraception by a pharmacist may be eligible for coverage by the Department of Health effective June 6, 2022. Each patient is eligible for a maximum of three (3) assessments per one-year period.

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

This program does not apply to prescribing of hormonal contraception eligible as a renewal under the Prescription Renewals by Pharmacists program.

Eligibility


Assessment for contraception management, with or without prescribing, may be eligible for coverage provided all the following criteria are met:

Patient

  • The patient is between the ages of 12 and 50.
  • The patient has a menstrual cycle and is not experiencing unusual menstrual changes.
  • The patient is not pregnant or breastfeeding or within 6 weeks post-partum.
  • The patient must have a valid Medicare card and not reside in a nursing home or a correctional facility.
  • A maximum of one (1) contraceptive management initial assessment PIN per patient within the past 12 months.
  • A maximum of one (1) contraceptive management subsequent assessment resulting in change in prescription PIN per patient within the past 12 months.
  • A maximum of one (1) contraceptive management subsequent assessment that does not result in a change in therapy PIN or contraceptive management 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 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.
    • dispensed in a supply not less than 84 days. Exceptions may be granted if, in the professional judgement of the pharmacist, it would be unsafe or unwise to do so, and the specific rationale is documented in the assessment and prescribing tool.
  • The drug prescribed for contraception management must be listed as a benefit on the NB Drug Plans formulary.
  • For prescriptions by a pharmacist to maintain a patient's existing therapy, the pharmacist should prescribe for an expected duration of one-year. Exceptions may be granted if, in the professional judgement of the pharmacist, it would be unsafe or unwise to do so, and the specific rationale is documented in the assessment and prescribing tool.
  • The assessment is not eligible if the primary purpose was prescribing and/or dispensing emergency contraception and a full contraception management assessment was not completed.
  • The assessment is not eligible if the patient qualifies for a prescription renewal. Exceptions may be granted if the pharmacist makes the clinical decision to perform a contraception management initial assessment and the specific rationale is documented in 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 contraception management assessment fees which have been paid for by the Department of Health. The applicable assessment definitions and fees are outlined below:

Table 1

Assessment Fee
Contraception Management initial assessment resulting in a prescription 
 $20
Contraception Management initial assessment that does not result in a prescription $20
Contraception Management subsequent assessment resulting in change of prescription 
 $20
Contraception Management subsequent assessment that does not result in a change in therapy
 $12
Contraception Management 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, 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
Contraception Management initial assessment resulting in a prescription  00904771
Contraception Management initial assessment that does not result in a prescription 00904772
Contraception Management subsequent assessment resulting in change of prescription  00904773
Contraception Management subsequent assessment that does not result in a change in therapy 00904774
Contraception Management subsequent assessment resulting in therapy discontinuation and/or referral   00904775

Pharmacy Audits


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

Service Exclusions


Claims for service fees for the following types of prescription are excluded:

  • Emergency contraception