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Frequency of Dispensing and Payment Policy Effective July 2, 2013The New Brunswick Prescription Drug Program (NBPDP) has implemented a Frequency of Dispensing and Payment Policy to establish criteria for dispensing drugs taken continuously (long-term). This policy has been implemented to address the increase in frequency of dispensing of such drugs and associated dispensing fees. Pharmacies are eligible for one dispensing fee every 28 days or more for drugs taken continuously. This policy applies to all claims for drugs in solid oral dosage form taken on a continuous basis. Continuous drugs are defined as those taken to treat long-term conditions such as high cholesterol, high blood pressure, or diabetes. Drugs prescribed to be taken on an ‘as needed’ basis and dispensed continuously are also included in this policy. Exceptions are permitted. Documentation requirements for these exceptions are outlined below. All submitted claims are subject to audit and recovery. Quick Links
New Drug StartsPharmacies are eligible for a dispensing fee on the initial claim for a drug not taken in the last 12 months* that is submitted for a period of less than 28 days if specified on the prescription by the prescriber. Pharmacies are eligible for a dispensing fee on subsequent claims for the same drug that are also dispensed within the first 28 days if specified on the prescription by the prescriber. Pharmacies are eligible for a maximum of 4 dispensing fees in the first 28 days of therapy. * Note: The adjudication system does not generate an electronic message to pharmacies if the patient has had the drug in the last 12 months. Pharmacists must confirm if the patient has taken the drug in the last 12 months (including physician samples). Dosage ChangesPharmacies are eligible for a dispensing fee each time there is a dosage change to an existing continuous drug. Pharmacies are eligible for a dispensing fee on subsequent claims for the same drug that are also dispensed within the first 28 days if specified on the prescription by the prescriber. Pharmacies are eligible for a maximum of 4 dispensing fees in the first 28 days of therapy. Drugs prescribed ‘as needed’Pharmacies are eligible for one dispensing fee every 28 days or more for drugs prescribed to be taken on an ‘as needed’ basis and dispensed continuously. Pharmacies are eligible for an additional dispensing fee for the same drug within the first 28 days if a new prescription is authorized by the prescriber. Replacement of lost or stolen drugsFor drugs that are lost or stolen, pharmacies are eligible for a dispensing fee that is the same amount as the dispensing fee paid on the lost or stolen prescription. Accommodation for holidaysPharmacies may bill claims earlier than required to accommodate statutory holidays, patient vacations or other scheduling issues. However, over an 84 day period, pharmacies are only eligible for three dispensing fees for drugs taken continuously. Batch/Cycle FillsWeekly Batch/Cycle Fills Pharmacies that choose to dispense on a weekly batch / cycle fill basis, can bill claims weekly; however, they are only eligible for ¼ of the dispensing fee, regardless if weekly dispensing has been prescribed or requested. This applies to all NBPDP beneficiaries including those living in nursing homes, special care homes or residential facilities whose drugs are managed for them. Bi-Weekly Batch/Cycle Fills Pharmacies that choose to dispense on a bi-weekly batch / cycle fill basis, can bill claims bi-weekly; however, they are only eligible for ½ of the dispensing fee, regardless if bi- weekly dispensing has been prescribed or requested. This applies to all NBPDP beneficiaries including those living in nursing homes, special care homes or residential facilities whose drugs are managed for them. Batch/Cycle Fill other than bi-weekly or weekly Pharmacies that choose to dispense on cycle fill other than bi-weekly or weekly, can bill claims in this manner, however they are only eligible for a partial dispensing fee up to one dispensing fee every 28 days, regardless if batch/cycle fill other than bi-weekly or weekly dispensing has been prescribed or requested. This applies to all NBPDP beneficiaries including those living in nursing homes, special care homes or residential facilities whose drugs are managed for them. The claim submission requirements for batch/cycle fills are outlined in the Claims Submission section. Exceptions to this policyThe following exceptions are not permitted for drugs dispensed to patients living in nursing homes, special care homes or adult residential facilities whose drugs are managed for them, regardless if weekly dispensing has been prescribed or requested.
Note: Claim SubmissionsClaims submitted for drugs that are typically taken to treat long-term conditions such as high cholesterol, high blood pressure, or diabetes, and are billed for less than 28 days, will receive a rejection message and the claim will not be paid. Claims submitted for drugs that are typically taken for a short period of time but are being taken continuously (long-term corticosteroid therapy, antibiotic prophylaxis), that are billed for less than 28 days will not receive a rejection message. To comply with the policy, pharmacies may need to submit a zero or partial dispensing fee for certain claims. Intervention Code ER If a rejection message is received for the following types of claims, the claims must be submitted using the CPhA Intervention Code ER.
Special Service Code P
Pharmacy Documentation RequirementsThe hard copy of the prescription is sufficient documentation for the following types of claims:
The hard copy of the prescription with details explaining the following situations is sufficient documentation for the following types of claims:
Additional documentation is required for the following types of claims:
Downloadable Frequency of Dispensing Authorization Forms
Pharmacy Audits
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