Assessment and Prescribing for Paxlovid by Pharmacists

The assessment and prescribing for nirmatrelvir / ritonavir (Paxlovid) by a pharmacist is eligible for coverage by the Department of Health effective September 22, 2022. Pharmacists are encouraged to add their names to the list of NB pharmacies offering this service by contacting New Brunswick Drug Plans via email at [email protected]. Alternatively, pharmacists can call New Brunswick Drug Plans at 1-800-332-3691.

Each patient is eligible for a maximum of three (3) assessments per one-year period.

If the assessment results in a prescription for nirmatrelvir / ritonavir (Paxlovid), information on how to submit a claim is available on the Coronavirus (COVID-19) Drug Therapies web page.
 

 
Assessment for nirmatrelvir / ritonavir (Paxlovid) treatment, with or without prescribing, may be eligible for coverage provided the following criteria are met:

Patient

• The patient is aged 18 and older.
• The patient presents with COVID symptoms, with symptom onset occurring within the past 5 days.
• The patient presents with a positive COVID PCR test (laboratory confirmed test), POCT test (rapid antigen test) or Abbott ID test. The patient’s verbal confirmation of the test type, result, and date is sufficient.
• The patient does not need a valid Medicare card.
• A maximum of three (3) Paxlovid assessment PINs of any combination per patient within the past 12 months.

Pharmacist

• The service is conducted preferably virtually or via telephone, or in person if needed, by a pharmacist licensed with the NB College of Pharmacists (NBCP).
• The prescribing pharmacist must complete the nirmatrelvir / ritonavir (Paxlovid) Eligibility Form if they write or adapt a Paxlovid prescription.  
• The pharmacist must comply with all applicable NBCP requirements and standards.

Prescription

Any of the following:

• The pharmacist prescribes nirmatrelvir / ritonavir (Paxlovid) DIN 02524031 or DIN 02527804.
• A prescription for nirmatrelvir / ritonavir (Paxlovid) received from another prescriber is adapted by the pharmacist due to an inappropriate dose.
• The nirmatrelvir / ritonavir (Paxlovid) Eligibility Form accompanying a prescription from another prescriber is incomplete or inaccurate and requires completion or correction by the pharmacist. This applies only to sections 2 and 4 of the nirmatrelvir/ritonavir (Paxlovid) Eligibility Form.

When a prescription for nirmatrelvir / ritonavir (Paxlovid) is dispensed, it must be:

• dispensed on the same day as the assessment is submitted for payment; and
• dispensed from the pharmacy submitting the assessment, unless the patient chooses to fill the prescription at another pharmacy, however, this must be documented on the patient record.
    

 
The Department of Health will pay participating providers for each claim billed for eligible patients in New Brunswick. The participating provider is not permitted to charge additional fees to the patient for nirmatrelvir / ritonavir (Paxlovid) assessment fees which have been paid for by the Department of Health. The applicable assessment definitions and fees are outlined below:

Table 1

 
Pharmacists must document how the eligibility criteria are met for the Assessment and Prescribing for Paxlovid by Pharmacists program for each patient.

The nirmatrelvir / ritonavir (Paxlovid) Eligibility Form must be completed if the assessment results in a prescription or an adaptation of a prescription.
 

 
Pharmacists must document how the eligibility criteria are met for the Assessment and Prescribing for Paxlovid by Pharmacists program for each patient.

The nirmatrelvir / ritonavir (Paxlovid) Eligibility Form must be completed if the assessment results in a prescription or an adaptation of a prescription.

Manual claims will not be accepted. Claims must be submitted online and include the following information:

Table 2

 
All claims submitted by participating providers for reimbursement are subject to audit and recovery.

Claims for nirmatrelvir / ritonavir (Paxlovid) assessment fees for the following service are excluded:

• Dispensing a prescription of nirmatrelvir / ritonavir (Paxlovid) for a patient who presents with a completed nirmatrelvir / ritonavir (Paxlovid) Eligibility Form and an associated prescription from another prescriber and no adjustments to the form or prescription are required.