Antiviral coverage for influenza outbreaks in nursing homes

Oseltamivir (Tamiflu and generic brands) and zanamivir (Relenza) are available as special authorization (SA) benefits for beneficiaries of the Nursing Home Residents Plan (Plan V) during an influenza outbreak. Eligible products are listed in the New Brunswick Drug Plans Formulary. 

Relief care bed program participants are not eligible for drug coverage. They are responsible to provide their own drugs for the time that the relief care bed will be used. 

Information on oseltamivir coverage for qualifying residents of New Brunswick adult residential facilities (ARFs) is available through Public Health. 

In the event of a respiratory outbreak in a nursing home, the primary care provider (attending physician, nurse practitioner or the nursing home’s medical advisor) will consult with the regional Medical Officer of Health (MOH) to determine if the cause of the respiratory outbreak is due to influenza. 

If the cause of the outbreak is determined to be or likely to be influenza, the MOH will make general recommendations regarding antiviral use in the nursing home. The responsibility for individual resident treatment during the outbreak remains with the primary care provider. 

It is important to begin antiviral treatment within 24 to 48 hours of symptom onset. Antiviral medication is unlikely to benefit residents who have been ill for more than 48 hours. Antiviral treatment should be continued for a maximum of five days, as a longer duration is unlikely to benefit most individuals. 

During an influenza outbreak, residents who are not presenting with influenza-like illness should be considered for antiviral prevention regardless of influenza vaccination status. Prophylaxis should be continued until the outbreak is declared over (eight days after symptom onset in the last case). 

The Association of Medical Microbiology and Infectious Disease Canada provides more guidance on the use of antiviral drugs for influenza.  

The nursing home’s medical advisor or other designated staff must notify the NB Drug Plans of the decision to start antiviral therapy in that nursing home by calling the NB Drug Plans Inquiry line at 1-800-332-3692. 

If it is outside regular business hours, a message containing the following information should be left: 

• name and address of the nursing home 
• start date of influenza outbreak 
• name and telephone number of a contact person at the nursing home 
• name and telephone number of the nursing home’s pharmacy 

Within 24 to 48 hours of notification, the NB Drug Plans will activate SA approval for oseltamivir capsules and zanamivir powder for inhalation for all beneficiaries of Plan V in the nursing home. 

Coverage of oseltamivir powder will be considered when oral capsules are not an option. A Special Authorization Request (PDF 551 KB) form must be submitted for each resident.  

The nursing home should contact the pharmacy at the same time as the NB Drug Plans to allow time to procure and dispense the quantity of antiviral required. NB Drug Plans will notify the pharmacy when SA approvals have been activated. 

If the pharmacy is unable to access adequate stock of antivirals, they should contact other pharmacies to obtain a supply. If they are unable to obtain a supply from another pharmacy, the pharmacy should contact McKesson directly at 1-506-855-5155 to obtain antivirals.  

The New Brunswick antiviral stockpile cannot be accessed for this purpose. 

Claims for antivirals must be submitted electronically according to the Pharmacy claim submissions process.