Government of New Brunswick

Seasonal Influenza Drug Therapy for Residents of Adult Residential Facilities


Oseltamivir (Tamiflu and generic brands) is available at no cost for qualifying residents of New Brunswick adult residential facilities (ARFs) who have been diagnosed with or exposed to seasonal strains of influenza. Patients must meet the eligibility requirements outlined below.

 

Eligibility


Oseltamivir is available at no cost for the treatment or prevention of seasonal influenza for ARF residents who are 19 years of age and older and meet one of the following criteria:

  • Treatment of seasonal influenza: For residents of any ARF who test positive, or are presumed positive, for influenza or develop influenza symptoms while taking prophylaxis. A list of eligible ARFs is available here.
  • Prophylaxis of seasonal influenza: For residents of Level 3 Generalist Care and Memory Care Homes when the Regional Medical Officer of Health has recommended prophylaxis. A list of eligible ARFs is available here

Note: Assessment and prescribing for seasonal influenza prophylaxis by pharmacists is eligible for coverage. Information on eligibility and how to submit a claim is available here

 

 

Eligible Drug Therapies


Qualifying residents of ARFs are eligible to receive oseltamivir for the treatment or prevention of seasonal influenza. Please refer to the New Brunswick Drug Plans Formulary for a complete list of eligible oseltamivir products.

Coverage of oseltamivir powder for suspension must be requested through special authorization and will be considered when oral capsules are not an option. Requests must indicate how the patient meets the eligibility criteria outlined above. Special authorization request forms are available online. 

 

Claim Submission


Pharmacists must ensure that the patient meets the eligibility criteria outlined above prior to submitting the claim.

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

Field Information Required

Carrier ID

NB

Group Number or Code

I (Note: this also applies to New Brunswick Drug Plans beneficiaries.)

Client ID

Patient’s NB Medicare number.  (Note: this also applies to New Brunswick Drug Plans beneficiaries.)

Enter “999 999 999” for individuals who do not have a NB Medicare number.

Note: If there is a requirement for a pharmacy to submit more than one claim on the same day for the same DIN under this pseudo Medicare number, subsequent claims must be submitted with Intervention Code “MG”.

Patient Code

Leave Blank

Patient Name

Patient’s first and last name

Patient DOB

Patient’s date of birth

Prescriber ID

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

Prescriber ID Reference Code

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

DIN / PIN

Please refer to the New Brunswick Drug Plans Formulary for a complete list of eligible oseltamivir products.

Quantity

Quantity dispensed

Days Supply

Number of days’ dispensed (see NB Drug Plans Claim Submissions web page).

Drug Cost / Product Value

 Please refer to Dispensing Fees and Drug Cost Reimbursement

Cost Upcharge

 Please refer to Dispensing Fees and Drug Cost Reimbursement

Professional Fee

$11.00

Intervention and Exception Code

MU
 

Pharmacy Audits


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

 

Exclusions


The following individuals are not eligible for coverage under this program:

  • Residents who have coverage of oseltamivir under a private or government funded drug plan
  • Health Care Workers (employees or volunteers) of the ARF