Drug Plan Formulary 2Nd Ed (June 2012).Pdf
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Disclaimer: This guide is offered as an easy reference to the prescription drugs that are supported by the National Prescription Drug Plan. It is by no means intended or to be construed as a directive to physicians to prescribe any of the drugs listed in the Formulary, nor does the National Insurance Board, by making available this guide, assume any responsibility for any treatment regimen or prescription drugs physicians prescribe for their patients with reference to the Formulary. The treatment and prescription process remains the sole purview of physicians in consultation with their patients. NATIONAL PRESCRIPTION DRUG PLAN FORMULARY TABLE OF CONTENTS Foreword ................................................................................. 3 Patient Registration Eligibility.................................................. 8 Completing Registration Forms .................................................. 9 Prescription Processing .......................................................... 10 Key Abbreviations .................................................................. 13 Arthritis .............................................................................. 16 Asthma ............................................................................... 45 Benign Prostatic Hypertrophy (BPH) ..................................... 58 Breast Cancer .................................................................. 63 Diabetes ............................................................................. 69 Epilepsy .............................................................................. 92 Glaucoma ......................................................................... 103 Hypercholesterolemia (High Cholesterol) ............................ 117 Hypertension .................................................................. 124 Ischaemic Disease ....................................................... 153 Prostate Cancer ............................................................ 170 Psychiatric Illness ........................................................ 177 Sickle Cell Anemia ............................................................... 201 Thyroid Diseases ................................................................. 204 ICD 9 Diagnosis Codes For NPDP Diseases ...................... 209 2 NPDP Formulary | Health Professionals Edition Foreword This booklet is intended to be a valuable resource for healthcare professionals by providing essential information regarding the National Prescription Drug Plan (NPDP). It gives an introduction to NPDP, information on patient registration, the processing of prescriptions and a comprehensive listing of the benefits offered by the Plan. Another important purpose is to answer questions you or your patients may have regarding NPDP. National data indicate that in 2010, one in three Bahamians was suffering from a chronic disease. Such ailments are costly in terms of human suffering and the expense of treatment and care. The National Insurance Board of The Bahamas, through the NPDP, seeks to reduce the health and financial burden of chronic diseases by targeting the following non-communicable diseases: arthritis, asthma, benign prostate hypertrophy, breast cancer, diabetes, epilepsy, glaucoma, hypercholestremia, hypertension, ischaemic disease, prostate cancer, psychiatric illness, sickle cell disease and thyroid disease. One element of the NIB strategy focuses on prevention by funding well organized and well managed health promotion and wellness projects in the community. The second element of the strategy addresses the following: NPDP Formulary | Health Professionals Edition 3 • Reducing cost - by negotiating medication prices through a public tender process • Increasing access- by utilizing private and public pharmacies, and • Improving health - through increased access to medications and wellness programmes. The Formulary combines both clinical and cost effectiveness. The listing of prescription drugs contained herein was developed through wide and intense consultation with practicing physicians and pharmacists in the public and private sector, as well as thorough research into similar plans that exist in other countries. We recognize that you and your patients desire choices when it comes to selecting medication. The NPDP has taken this into consideration by making available options within most of the drug classes. We ask for your assistance in supporting the goal of the NPDP to provide cost-effective therapy by being mindful of cost and appropriate use in prescribing. Another area for choice allows patients to receive their prescription benefits at any participating public or private pharmacy. The drug information in this booklet covers the products and diseases in the NPDP and is not intended to serve as a comprehensive database. If you have any questions regarding information contained herein, please contact the NPDP pharmacists for further details. If you require additional copies of any NPDP form or publication, please contact the NPDP office at 356-2032, NIB Headquarters 4 NPDP Formulary | Health Professionals Edition 502-1500, toll- free 242-300-0001 or fax 356-2026. You may also visit us online at www.nibdrugplan.com or www.nib-bahamas.com. NPDP Formulary | Health Professionals Edition 5 The National Insurance Board is grateful for your interest and support. We appreciate feedback and suggestions as to how this guide or any aspect of our services may be improved or expanded to serve you and your patients in a more efficient manner. Thank you and we look forward to providing exceptional service to you and your patients. Director The National Insurance Board 6 NPDP Formulary | Health Professionals Edition Formulary Committee Eugene Gray, MD, Chairman Kevin Bowe, MD Brenna Turnquest, Pharm. D Laura Pratt-Charlton, RPh Vivienne Lockhart, RPh Ilsa Grant-Taylor, MD Marcia Bassett, MD Specialist Review Sub-Committee Timothy Barrett, MD Conville Brown, MD Patrick Cargill, MD Dionne Dames, MD John Lunn, MD Kevin Moss, MD Vincent Nwosa, MD K.J.A. Rodgers, MD Adrian Sawyer, MD Dean Tsertopoulos, MD Geoffrey Sweeting, MD Theodore Turnquest, MD NPDP Formulary | Health Professionals Edition 7 Introducing The National Prescription Drug Plan In order to reduce the overall health expenditure burden, the National Insurance Board has devised the National Prescription Drug Plan as one of the benefits offered to its subscribers. It is hoped that by providing high quality, cost- effective medications and increased access, we can minimize the impact of chronic diseases in the Bahamas. Patient Registration Eligibility The National Prescription Drug Plan (NPDP) covers patients in the following categories: • NIB Pensioners receiving: o Retirement Benefit or Grant o Old-Age Non Contributory Pension o Survivors Benefit/Assistance (age 60 & over) o Disablement Benefit assessed at 100% • NIB Invalids receiving: o Invalidity Benefit o Invalidity Assistance • Bahamian citizens age 65 and over • Children o under 18 years o under 25 years (if full-time students) • Indigent persons • Government employees/Civil Servants • Women receiving ante-natal and post-natal care A person falling into one of the foregoing categories and 8 NPDP Formulary | Health Professionals Edition diagnosed with a covered chronic disease is eligible for NPDP, regardless of income, financial status, health insurance, or nationality. NOTE: Patients seeking to enroll and access the benefits of NPDP should possess a valid NIB number. Completing Registration Forms To register a patient for the NPDP, a licensed physician in The Bahamas needs to complete and sign Section 2 of the Patient Registration Form (DP-1). The ICD-9 code needs to be included in the diagnosis. Special Terms Regarding Diagnosis Certain diseases are considered to need specialist treatment. Diagnosis of these diseases, for the purposes of NPDP, is limited to the following certified medical specialists: • Psychiatric Illnesses: diagnosis by a psychiatrist. • Breast Cancer: diagnosis by an oncologist or surgeon. • Prostate Cancer: diagnosis by urologist or oncologist. • Glaucoma: diagnosis by an opthalmologist. Completing the Registration Process Patients must take the completed form to the NPDP office to complete the registration process and receive their ACE Rx card. Once in receipt of their card, they may fill eligible prescriptions at any participating pharmacy. NPDP Formulary | Health Professionals Edition 9 Prescription Processing Pharmacies must be registered with the NPDP to be eligible to process prescriptions for members. Patients should present their eligible prescription along with their ACE Rx card. To begin processing a NPDP prescription, the pharmacist needs to swipe the ACE Rx card through the card reader and enter the prescription information into the EPOS System. This will submit the information for processing, which will verify the eligibility of the patient and prescription. Within five (5) seconds the claim will be processed, and an approval or denial will be returned through the EPOS System. If approved, the pharmacist should then finish filling the prescription, using formulary medications purchased through the approved distributors. The authorization code returned by the Processing Centre verifies the claim has been submitted to NPDP for processing and will be paid on the next weekly pay date. If denied, a rejection message will appear. If there are any questions regarding the denial, you may contact the NPDP office for clarification.