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New Brunswick Prescription Drug Program Formulary

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New Brunswick Prescription Drug Program Formulary NEW BRUNSWICK PRESCRIPTION DRUG PROGRAM FORMULARY Copyright - 2003 The Queen In the right of The Province of New Brunswick as represented by The Honourable Elvy Robichaud Minister of Health and Wellness ADMINISTERED BY ATLANTIC BLUE CROSS CARE ON BEHALF OF THE GOVERNMENT OF NEW BRUNSWICK TABLE OF CONTENTS Page Introduction to the New Brunswick Prescription Drug Program Formulary I The New Brunswick Prescription Drug Program I New Brunswick Prescription Drug Program Plans II - III Exclusions IV - V Extemporaneous Preparations and Placebos VI Benefit Review Process VII Product Deletion VII Submission Requirements VIII Legend IX Comment Sheet X Pharmacologic - Therapeutic Classification of Drugs 4:00 Antihistamines 1 8:00 Anti-Infective Agents 3 10:00 Antineoplastic Agents 28 12:00 Autonomic Drugs 33 20:00 Blood Formation and Coagulation 43 24:00 Cardiovascular Agents 49 28:00 Central Nervous System Agent 76 40:00 Electrolytic, Caloric and Water Balance 128 48:00 Antitussives, Expectorants & Mucolytic Agents 133 52:00 Eye, Ear, Nose and Throat (EENT) Preparations 135 56:00 Gastrointestinal Drugs 149 60:00 Gold Compounds 159 64:00 Heavy Metal Antagonists 160 68:00 Hormones and Synthetic Substitutes 161 80:00 Serums, Toxoids, and Vaccines 179 84:00 Skin and Mucous Membrane Agents 180 86:00 Smooth Muscle Relaxants 198 88:00 Vitamins 201 92:00 Unclassified Therapeutic Agents 205 TABLE OF CONTENTS Page Appendices I-A Abbreviations of Dosage Forms A-1 - A-3 I-B Abbreviations of Routes A-4 - A-5 I-C Abbreviations of Units A-6 - A-7 II Abbreviations of Manufacturers' Names A-8 - A-9 III Extemporaneous Preparations A-10 IV Special Authorization A-11 IV Special Authorization Drug Criteria A-12 NEW BRUNSWICK PRESCRIPTION DRUG PROGRAM FORMULARY Introduction The New Brunswick Prescription Drug Program Formulary is a listing of all drugs and drug products which have been determined by the Minister of Health and Wellness to be entitled services. Such drugs and drug products must be listed in the New Brunswick Prescription Drug Program Formulary, in order to be considered current eligible benefits. Entitled services which are considered to be interchangeable and available for product selection are noted. The drugs are listed by Therapeutic Category in accordance with that established by the AHFS Drug Information. Each entry is cross-indexed by trade name, generic name and drug identification number (DIN). The New Brunswick Prescription Drug Program Formulary is updated quarterly and produced once yearly on compact disc (CD). Each provider pharmacy and authorized dispensing physician is provided with an electronic copy of the publication on (CD). An electronic copy on CD is available upon request to all physicians registered with Medicare. An electronic copy in Portable Document Format (PDF) is also maintained on the NBPDP web page; http://www.gnb.ca/0051/0212/index-e.asp. To have your name added to the e-mail mailing list to receive an electronic copy, please send a message to [email protected]. New Brunswick Prescription Drug Program The Prescription Drug Program was established to improve and maintain the well-being of the people of the province by making available specified drugs to selected target groups. The program is monitored by the Advisory & Utilization Committee which includes representatives of the health care professionals involved, department administration and laypersons. This committee makes recommendations to the Minister of Health and Wellness on the addition and deletion of benefits to the various plans. I June 2003 New Brunswick Prescription Drug Program Plans Participating Legislative Plans Fees Beneficiaries Authority A $9.05 per prescription up to an Eligible residents of the province Prescription Drug annual copay ceiling of $250 who are sixty-five years of age Payment Act and for GIS recipients. or older Regulations $15.00 per prescription with no annual ceiling for non-GIS recipients B $50 per year registration fee(1); Persons with cystic fibrosis who Prescription Drug 20% of cost of prescription to a are eligible residents and Payment Act and maximum of $20 per registered with the Department Regulations prescription up to an annual of Health and Wellness ceiling of $500 per family unit E $4 per prescription; up to an Persons in licensed residential Health Services annual copay ceiling of $250 facilities who are in receipt of Act and per person(2) financial assistance from the Regulations Department of Family & Community Services and hold a valid health card issued by Family & Community Social Services F $4 per prescription for adults Family and Community Services Health Services (18 years and over) clients Act and $2 per prescription for children Regulations (under 18 years); up to an annual copay ceiling of $250 per family unit(2) G None Children in care of the Minister Health Services of Health and Wellness and Act and special needs children Regulations H $50 per year premium; copay Persons with multiple sclerosis Prescription Drug ranges from zero to 100 per who are eligible residents and Payment Act and cent for each prescription registered with the Department Regulations of Health and Wellness R $50 per year registration fee(1); Solid organ transplant recipients Prescription Drug 20% of cost of prescription to a who are eligible residents and Payment Act and maximum of $20 per registered with the Department Regulations prescription up to an annual of Health and Wellness ceiling of $500 per family unit II June 2003 New Brunswick Prescription Drug Program Plans Participating Legislative Plans Fees Beneficiaries Authority T $50 per year registration fee(1); Persons with growth hormone Prescription Drug 20% of cost of prescription to a deficiency who are eligible Payment Act and maximum of $20 per residents and registered with the Regulations prescription up to an annual Department of Health and ceiling of $500 per family unit Wellness U $50 per year registration fee(1); HIV-infected persons who are Prescription Drug 20% of cost of prescription to a eligible residents and registered Payment Act and maximum of $20 per with the Department of Health Regulations prescription up to an annual and Wellness ceiling of $500 per family unit V None Eligible residents of Nursing Prescription Drug Homes as defined in the Nursing Payment Act and Home Act operated by a licensee Regulations under the Act Special Plan dependent (3) Persons approved to have Prescription Drug Authorization payment made for certain drugs Payment Act following medical consultation Non-NBPDP Participating Legislative Fees Plan Beneficiaries Authority W $9.05 per prescription Extra Mural Hospital patients Hospital Services who are in possession of a Act Prescription Drug Authorization Form (1) Family and Community Services clients are exempted from these fees. (2) Exempted from these fees for oral contraceptives. (3) See Appendix IV. III June 2003 Exclusions While only products listed in the New Brunswick Prescription Drug Program Formulary are benefits the following are some of the specific products not included: 1. Patent medicines such as Jack and Jill Cough Syrup, Extract of Wild Strawberry, etc. 2. Non-prescription acetylsalicylic acid (ASA) preparations except enteric coated ASA products designated as benefits. 3. Non-prescription mouth, throat and nasal preparations, including decongestants 4. Prescription and non-prescription, Cough and Cold products (antitussives, expectorants and decongestants) except those designated for children in care & Cystic Fibrosis beneficiaries. 5. (a) Non-prescription adult vitamins with or without iron supplements (Plans A, E, F [over 18 years of age]) as a dietary supplement (b) Multivitamins (prescription and non-prescription) as a dietary supplement 6. Non-prescription tonics and compounded iron preparations (except single entity iron preparations designated as benefits) 7. Dietary/nutritional supplements and food products 8. Artificial sweetening agents 9. Weight loss products (prescription and non-prescription) 10. Calcium preparations (prescription and non-prescription) as a dietary supplement 11. Laxatives (Plans A, E,F and G) 12. Antacids (Plans A only) 13. Smoking cessation products 14. Ergoloid mesylates, oral, (Hydergine) 15. Potassium supplements, oral, when supplied as K-Lyte effervescent tablets, lime or orange flavoured 16. Retinoic acid (eg. Tretinoin) topical and oral preparations (Plan A only) 17. Cosmetic, health, dental and beauty aids, and cosmetic drugs 18. Soaps, cleansers and shampoos, medicated or otherwise 19. Appliances, prosthetic or otherwise, including first aid supplies and syringes IV June 2003 20. Diagnostic agents 21. Household remedies e.g. calamine lotion, iodine, hydrogen peroxide, antiseptics and disinfectants 22. Injectables or other products normally administered in a hospital setting or requiring a health care professional for administration and/or monitoring to ensure the appropriate standard of patient care is provided 23. Any insured service for which the resident is entitled to benefit under Department of Veterans Affairs, Workplace Health & Safety Compensation Commission or other legislation 24. Delivery, postal or C.O.D. charges 25. Refills in excess of the number specified by the physician or any refill of a prescription older than one year unless approved for refill by the prescriber 26. Antihistamines (Plans A, E, F, V and W) 27. Benzoyl Peroxide preparations in strengths of 5% or less. 28. Lactase Enzyme products. 29. All drug products used for the treatment
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