Payment policy for parenteral sterile preparations

This policy applies to all participating providers of the New Brunswick Drug Plans. The New Brunswick Drug Plans include the New Brunswick Prescription Drug Program (NBPDP), New Brunswick Drug Plan (Plan D) and other government sponsored programs, including the Extra-Mural Program (Plan W).

Eligible parenteral sterile preparations are those that contain drugs for infusion in CADD cassettes, IV bags and elastomeric pumps.      

All drugs in a sterile preparation must be listed on the New Brunswick Drug Plans Formulary. If a preparation contains a drug (DIN) not listed on the Formulary, special authorization is required.

The following definitions apply in this policy:

CADD cassette: the reservoir that contains medication that is delivered in a Continuous Ambulatory Deliver Device (CADD) pump

Diluent: a liquid that decreases the concentration of a solution or turns powder into a liquid

Elastomeric pump: a pump that uses pressure to infuse medication

IV bags: a sterile bag used to hold drugs that are administered to a patient intravenously

Prescription record: all information recorded in written and electronic format pertinent to the prescription dispensed. For payment of parenteral sterile preparations, the following information is required:

1. prescription number
2. date the prescription was dispensed
3. name of the patient
4. patient’s Medicare or drug plan ID number
5. name of the prescriber
6. drugs and other ingredients contained in the sterile preparation, including the name, strength, quantity, manufacturer’s name and drug identification number (DIN), Product Identification Number (PIN) or Natural Product Number (NPN) 
7. supplies used for the sterile preparation, including the name and quantity
8. dosage instructions
9. signature of pharmacist performing final check

Worksheet: a document that specifies the amounts and costs of all ingredients contained in and supplies used to prepare each sterile preparation.

The pharmacy must submit a worksheet for each type of preparation (drug and quantity) using the NB Drug Plans worksheet template. The worksheet may be obtained by emailing [email protected].

A worksheet must include the cost of each eligible item (Table 1) and be approved before a claim for the preparation is submitted. If a worksheet is submitted outside of normal business hours, every effort will be made to review the worksheet by the end of the next business day.

Submit worksheets and invoices for eligible supplies and special packaging to [email protected]. If there is a price change for any approved supplies or special packaging, the applicable worksheets must be resubmitted with the new price and invoice.

Approved worksheets will be emailed to the pharmacy to confirm that claims may be submitted.

To minimize wastage, every effort must be made to use the most appropriate strength and quantity of drug needed. The pharmacy must submit the corresponding prescription record within five days of the submission of each claim. The information required in the prescription record is outlined in the Definitions section.

If the prescription record is not received within five business days, the NB Drug Plans will send the pharmacy (by fax or secure email) the prescription numbers of the records not received. If the prescription record is not received within five business days of the date of the fax or email, the claim will be reversed by the NB Drug Plans. This reversal will show as a deduction on a future payment summary.

Sterile preparation claims and corresponding prescription records will be reviewed to ensure they match the approved worksheet. Overbilled claims will be reversed and resubmitted by the NB Drug Plans. The reversal and resubmission will show on a future payment summary. No action is required by the pharmacy.

All claims submitted to the NB Drug Plans for payment are subject to audit and recovery.