Oseltamivir (Tamiflu®) and zanamivir (Relenza®) are available as special authorization (SA) benefits for New Brunswick Prescription Drug Program (NBPDP) (Plan V) beneficiaries who are residents of long-term care (LTC) facilities during an influenza outbreak. This pertains to licensed nursing homes and does not include special care homes.
The SA criteria can be found in the New Brunswick Drug Plans Formulary.
In the event of a respiratory outbreak in a LTC facility, the attending physician or the facility’s Medical Advisor/House Physician will consult with the regional Medical Officer of Health (MOH) to determine if the cause of the outbreak is, or believed to be 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 facility. The responsibility for individual resident treatment or prophylaxis decisions during the outbreak remains with the attending physician.
If antiviral use is recommended by the MOH then the process for coverage of antivirals should be followed.
Process for Coverage of Antivirals
The LTC facility’s Medical Advisor/House Physician or other staff designated by the facility should notify the NBPDP of the decision to start antiviral therapy in that LTC facility by calling the NBPDP Inquiry line at 1-800-332-3691.
If it is after regular work hours, a message containing the following information should be left:
- Date of message
- Name and address of the LTC facility
- Name of pharmacy filling the prescriptions for antivirals and
- Name and telephone number of a contact person at the LTC facility in case the NBPDP needs to clarify any details.
The LTC facility’s pharmacy should be contacted at the same time as the NBPDP to allow time to secure and dispense the quantity of antiviral required.
If the pharmacy is unable to provide adequate stock of antivirals:
- The pharmacy 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:
T. 506.855.5155 | F. 506.861.0866 to obtain antivirals.
Note: The NB antiviral stockpile cannot be accessed for this purpose.
It is important to begin antiviral treatment within 24-48 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 outbreak, residents who do not have an influenza-like illness should be put on antiviral prophylaxis regardless of influenza vaccination status. Prophylaxis should be continued until the outbreak is declared over (7 days after symptom onset in the last case at the facility).
For more information, please refer to the following link: Association of Medical Microbiology and Infectious Disease Canada.
Claim Submission
When notified by the LTC facility that antiviral therapy has been ordered for residents, NBPDP will initiate special authorization approval for all beneficiaries of Plan V (nursing home residents) in the facility.
NBPDP will notify the pharmacy when special authorization for the antiviral has been activated and the pharmacy can then bill claims on-line.
Approval for antiviral therapy for relief care residents who are not beneficiaries of Plan V must be done separately. The LTC facility must notify NBPDP if they have any relief care residents.