Government of New Brunswick

Assessment and Prescribing for Uncomplicated Urinary Tract Infection by Pharmacists

The assessment and prescribing for Uncomplicated Urinary Tract Infection (UTI) by a pharmacist is eligible for coverage by the Department of Health effective October 1, 2021. Each patient is eligible for a maximum of two UTI assessments per one-year period.

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

Eligibility


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

Patient

  • The patient presents with an uncomplicated UTI.
  • The patient must have a valid Medicare card and not reside in a nursing home or a correctional facility.
  • The patient is between the ages of 16 and 64, and has previously been diagnosed with an uncomplicated UTI by a physician or nurse practitioner.
  • A maximum of two (2) uncomplicated UTI assessment PINs of any combination 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 an uncomplicated UTI must be listed as a benefit on the NB Drug Plans formulary.

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

Table 1

Assessment

Fee

Uncomplicated UTI assessment that results in a prescription

$20

Uncomplicated UTI assessment that does not result in a prescription

$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, 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

Uncomplicated UTI assessment that results in a prescription

11112000

Uncomplicated UTI assessment that does not result in a prescription

11112001

Pharmacy Audits


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