Update regarding New Brunswick’s Prescription and Catastrophic Drug Insurance Act and the New Brunswick Drug Plan

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In an effort to keep you abreast of new developments, we continue to follow the New Brunswick public drug plan closely.  We have details regarding unique stipulations that plan sponsors like you will need to consider when working to align your existing drug plan with the mandatory requirements of the New Brunswick public drug plan.

Background

On December 10, 2013, New Brunswick introduced the Prescription and Catastrophic Drug Insurance Act in the Legislative Assembly.  The Act and Regulation will have an important impact on New Brunswickers and private plan sponsors and is being rolled out in two phases: a voluntary program which came into effect May 1, 2014 and a mandatory program to take effect April 1, 2015.

This legislation lays the framework for the creation of a comprehensive premium-based public drug program for uninsured New Brunswickers.

Highlights

To protect plan members against high out-of-pocket costs, one of the following two provisions must be in place for all drugs listed on the New Brunswick Prescription Drug Program formulary:

    • a maximum out-of-pocket for each beneficiary1 no greater than $2,000 per year; or
    • no deductible, and a co-payment that is no greater than $30 per prescription.

For a private plan that provides multiple options such as flexible benefit plans, at least one option must meet all of the above criteria, and beneficiaries must be allowed to change to that option once a year, or after a life event (such as birth, death or marriage).

What is Sun Life doing to get ready for the change?

Sun Life continues to be an active participant in meetings with the Ministry of Health officials from the Province of New Brunswick and these meetings are facilitated by the CLHIA on behalf of all insurance companies.  Please visit www.gnb.ca (under the section “For Residents”) for up-to-date information about the New Brunswick Drug Plan.  In addition, a Q&A developed and released by the New Brunswick government is also attached.

The information contained in this communication is accurate as of the time of publishing.  This legislation is still under review and is subject to change.  We will update you with new details as we receive them.

Talk to your representative

The new minimum coverage standards will be coming into effect April 1, 2015, and Sun Life is actively working towards making the system, contract and administrative practice changes required by this new legislation. Please reach out to your group representative or advisor with any questions.  

As a reminder, we have included the valuable information from our previous communication below:

Upcoming Key Dates

May 1, 2014 – New Brunswickers will have voluntary access to the New Brunswick Drug Pan.  

April 1, 2015 – All New Brunswickers must be a member of a prescription drug plan with benefits that is comparable to the government-sponsored plan or be enrolled in the New Brunswick Drug Plan.

Who is eligible to enroll for the voluntary access of the New Brunswick Drug Plan?

Effective May 1, 2014, the New Brunswick Drug Plan will be available to New Brunswickers who have a valid New Brunswick Medicare Card and fall into one of two categories:

  1. Do not have private prescription drug plan coverage
  2. Do have private prescription drug plan coverage and meet one of the following criteria:
    1. Have already reached their annual or lifetime drug coverage maximum; OR
    2. Require a specific drug that is on the New Brunswick Prescription Drug Program (NBPDP) formulary but is not on their current prescription drug plan(s). 

Important Details about the New Brunswick Drug Plan

The voluntary plan will have a 30% co-payment, with a maximum of $30 per prescription for all participants.  The premiums for the plan will range between $800 and $2,000 per year, per adult, depending on individual (if single) or family income.

The plan will cover approved drugs that are on the New Brunswick Prescription Drug Program formulary (http://www.gnb.ca/0212/nbpdpformulary-e.asp), which adheres to a national evidenced-based drug review process currently used by public drug plans across Canada.

Key Considerations

  • Private plans cannot amend or cancel prescription drug coverage with the intent to transfer costs to the provincial plan – effective immediately and continuing until March 31, 2015, legislation will prohibit plans from amending or cancelling prescription drug coverage if the primary purpose of the amendment or the cancellation is to transfer costs to the New Brunswick Drug Plan.
  • Minimum coverage standards for private plans - effective April 1, 2015, plans will be required to meet certain minimum coverage standards:
    1. All drugs listed as a minimum requirement on the New Brunswick Prescription Drug Program formulary must be covered.
    2. All members of the family unit must be offered coverage.
    3. Coverage cannot be refused on the basis of the age, gender or state of health of any member of the family unit.
    4. There must be no annual or lifetime limit on the amount of coverage for drugs listed on the New Brunswick Prescription Drug Program formulary.
    5. To protect plan members against high out-of-pocket costs, one of the following two provisions must be in place for all drugs listed on the New Brunswick Prescription Drug Program formulary:
      i.  a maximum out-of-pocket for each beneficiary no greater than $2,000 per year; or
      ii. no deductible, and a co-payment that is no greater than $30 per prescription.
    6. For a private plan that provides multiple options, at least one option must meet all of the above criteria, and beneficiaries must be allowed to change to that option once a year, or after a life event (such as birth, death or marriage).
    7. Private drug insurance plans must be offered, and must meet these standards if the group plan provides any of the following benefits: vision, dental, medical insurance, or a health spending account.  However, there are no similar requirements for: disability, life, accidental death or dismemberment, or critical illness insurance.

1 Beneficiary is defined as the employee and their spouse along with their dependent children under the age of 19 (or under the age of 26 for full time students)

Questions?

Please contact your Client Service Administrator at 1-877-786-7227.