Special Authorization

Certain drugs are only eligible for coverage under NB Prescription Drug program through special authorization. The criteria are developed by the Atlantic and Canadian Expert Advisory Committees.

• Drugs listed as special authorization benefits have specific criteria for coverage which must be met in order to be approved.
• Under exceptional circumstances, requests for drugs without specific criteria may be reviewed case-by-case and assessed based on the published medical evidence.

Drugs not eligible for consideration through special authorization:

• New drugs not yet reviewed by the expert advisory committee
• Drugs excluded as eligible benefits further to the expert advisory committee’s review and recommendation
• Drugs not licensed or marketed in Canada (e.g. drugs obtained through Health Canada’s Special Access Program)
• Products specifically excluded as benefits as identified on the exclusion list (Formulary pages IV and V)

Reimbursement of brand name products when generics exist

When interchangeable generic products are available for a brand name drug, the New Brunswick Prescription Drug Program (NBPDP) will only reimburse pharmacies for the lowest cost generic product. Beneficiaries, who choose to receive a brand name product when a generic product exists, are responsible for paying any difference in price.

The NBPDP will consider requests for reimbursement of brand name drugs when a beneficiary has had a hypersensitivity reaction (e.g. edema, respiratory distress, serum sickness, anaphylaxis) to a non-medicinal ingredient contained in the interchangeable generic product. Requests may be made by submitting a completed Special Authorization Request Form and providing details of the hypersensitivity reaction.

Information on the safety and effectiveness of generic drugs is available on Health Canada’s website at http://www.hc-sc.gc.ca/hl-vs/iyhvsv/ med/med-gen-eng.php.

To request coverage through Special Authorization, the prescriber should mail or fax the following information:

Patient Identification

• Name of patient
• NB Medicare number
• Date of birth

Prescriber Identification

• Name, address, telephone number and FAX number (if applicable) of prescriber

Drug Requested

• Drug name, strength and dosage form
• Dosage schedule
• Expected duration of therapy

Reason for the Request

• Diagnosis and/or indication for which the drug is being used
• Information regarding previous drugs which have been used and the patient ’s response to therapy where appropriate
• Any additional information that may assist in making a decision on the request for special authorization.

Special authorization requests for beneficiaries of Plans A,B,E,F,G,R,V should be sent by mail or FAX to:

Special Authorization Unit
New Brunswick Prescription Drug Program
P.O. Box 690
Moncton, NB E1C 8M7
Local Fax: 506-867-4872
Toll Free Fax: 1-888-455-8322
NBPDP Inquiry Line: 1-800-332-3691

Plan U (HIV - Infected Persons) special authorization requests should be sent by mail or FAX to:

Special Authorization Unit – Plan U
New Brunswick Prescription Drug Program
P.O. Box 690
Moncton, NB E1C 8M7
Local fax: 506-867-4339
Toll Free Fax: 1-866-770-7746
Toll Free Telephone: 1-800-332-3691