Government of New Brunswick

Payment 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 and Extra-Mural Program (EMP).

Eligible Preparations


The 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 NB Drug Plans Formulary (regular benefit or special authorization benefit for which approval has been granted). If a preparation contains a drug (DIN) not listed on the NB Drug Plans Formulary, special authorization is required.

Worksheet Requirements

 
  • The pharmacy must submit a worksheet for each type of preparation (drug and quantity) using the NB Drug Plans worksheet template which may be requested by emailing [email protected].
  • A worksheet must be approved before a claim for the preparation is submitted. If a worksheet is submitted outside of normal business hours for the NB Drug Plans, every effort will be made to review the worksheet by the end of the next business day.
  • The worksheet must include the cost of each eligible item (see Table 1).
  • 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.

 

Pharmacy Claim Requirements

 

  • To minimize wastage, it is expected that every effort will be made to use the most appropriate strength and quantity of drug needed.
  • The pharmacy must submit the corresponding prescription record within 5 days of the submission of each claim. The information required in the prescription record is outlined in the Definitions section below.
  • If the prescription record is not received within 5 business days, the NB Drug Plans will send the pharmacy (by fax or secure email) the prescription numbers of the prescription records not received. If the prescription record is not received within 5 business days of the date of the email or fax, 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. 

 

Claim Submission Process


Claims submitted by participating providers must include the following information:

Field

Information Required

Carrier ID

NB

Group Number or Code

Plan Identification Letter (refer to NB Drug Plans Claim Submissions web page)

Client ID

Patient’s Plan ID number or Medicare number (refer to NB Drug Plans Claim Submissions web page)

Patient Code (NB Drug Plan only)

Patient’s ID number (refer to NB Drug Plans Claim Submissions web page)

Patient Name

Patient’s first and last name

Patient DOB

Patient’s date of birth

Prescriber ID

Prescriber’s license or registration number (refer to NB Drug Plans Claim Submissions web page)

Prescriber ID Reference Code

Code identifying a prescriber’s licensing body  (refer to NB Drug Plans Claim Submissions web page)

DIN / PIN

Drug Identification Number / Product Identification Number

Quantity

Quantity dispensed

Days Supply

Number of days’ supply dispensed (refer to NB Drug Plans Claim Submissions web page)

Unlisted Compound Code

6 = injection or infusion

Drug Cost / Product Value

Total cost of:

  • Drug(s)
  • Supplies
  • Special packaging (see Table 1)
  • Sterile preparation fees (see Table 2)

Cost Upcharge

Zero

Dispensing Fee

Up to $16.50

 

Table 1 – Eligible items and Cost Base

 

Component

Items

Eligible

Cost base

Mark-up

Drug

Drug Cost

Yes

(Must be listed in the NB Drug Plans Formulary or have SA approval)

up to MLP / MAP

up to 8% mark-up

Supplies applicable to a particular prescription

Diluent

Yes

AAC

 

-

 

Syringes

Yes

Needles

Yes

Needle filters

Yes

Repeater pump tube set

Yes

Sterile surgical gloves

Yes

Other supplies (e.g. disinfectant wipes, alcohol swabs)

No

-

-

Special packaging

CADD cassette

Elastomeric pump

No

(for EMP patients)

-

(Provided by EMP)

-

Yes

(for non-EMP patients)

AAC

-

IV bag

Yes

AAC

-

Sterile garb

Protective coveralls

No

(Part of sterile prep fee)

-

-

Shoe covers

Face masks

Hair nets / Bouffant caps

Other supplies (e.g. disinfectant wipes, alcohol swabs)

 

Table 2 - Sterile Preparation Fees

Product

Quantity

Sterile Preparation Fee

Dispensing Fee

CADD cassette

1 x 100 mL

up to $34.50

 

 

 

 

 

 

Add up to $16.50

2 x 100 mL

up to $44.50

IV bag

1 to 2

up to $29.50

3 to 7

up to $54.50

8 or more

up to $64.50

Elastomeric

pump

1 to 2

up to $19.50

3 to 7

up to $34.50

8 to 14

up to $44.50

15 or more

up to $54.50

 

Examples of Parenteral Sterile Preparation Claims

 

IV Bags or Elastomeric pumps

One drug product (e.g. 21 Cefazolin 1g IV bags)

Field

Information Required

DIN / PIN

Cefazolin 1 g vial (DIN listed in Formulary)

Quantity

21

Unlisted Compound Code

6 = injection or infusion

Drug Cost / Product Value

Total amount for the following:

  • Drug MLP/MAP + up to 8% mark-up
  • AAC of supplies and special packaging (refer to Table 1) 
  • Sterile preparation fee (refer to Table 2)

Cost Upcharge

Zero

Dispensing Fee

Up to $16.50

 

Two drug products/DINs (e.g. 21 Cefazolin 2 g elastomeric pumps)

Field

Information Required

DIN / PIN

Cefazolin 10 g vial (DIN listed in Formulary)

or

Cefazolin 1 g (DIN listed in Formulary)

Note: If one drug requires special authorization, the DIN of this drug must be used.

Quantity

21

Unlisted Compound Code

6 = injection or infusion

Drug Cost / Product Value

Total amount for the following:

  • Drug MLP/MAP + up to 8% mark-up
  • AAC of supplies and special packaging (refer to Table 1) 
  • Sterile preparation fee (refer to Table 2)

Cost Upcharge

Zero

Dispensing Fee

Up to $16.50

 

CADD cassettes

One drug product (e.g. 100 mL Hydromorphone 20 mg/mL CADD cassette)

Field

Information Required

DIN / PIN

Hydromorphone 20mg/mL (DIN listed in Formulary)

Quantity

100

Unlisted Compound Code

6 = injection or infusion

Drug Cost / Product Value

Total amount for the following:

  • Drug MLP/MAP + up to 8% mark-up
  • AAC of supplies and special packaging (refer to Table 1) 
  • Sterile preparation fee (refer to Table 2)

Cost Upcharge

Zero

Dispensing Fee

Up to $16.50

 

Definitions


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: An intravenous (IV) bag is a sterile bag used to hold drugs that are administered to a patient intravenously.

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

a)    Prescription number
b)    Date the prescription was dispensed
c)     Name of the patient
d)    Patient’s Medicare or drug plan ID number
e)    Name of the prescriber
f)      Drugs and other ingredients contained in the sterile preparation, including the name, strength, quantity, manufacturer’s name and drug identification number (DIN) or Product Identification Number (PIN) or Natural Product Number (NPN), if applicable
g)    Supplies used for the sterile preparation, including the name and quantity
h)    Dosage instructions
i)      Signature of pharmacist performing final check

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