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

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On December 10, 2013, New Brunswick introduced their Prescription and Catastrophic Drug Insurance Act, providing New Brunswickers with access to a government-sponsored prescription drug insurance plan (the New Brunswick Drug Plan), administered by Medavie Blue Cross.  This prescription drug insurance plan will be jointly funded by the government and plan participants in accordance with their ability to pay.  New legislation will fall under this Act.

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 for the New Brunswick Drug Plan?

Effective May 2, 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

We suggest to review your plan in light of the province’s new drug plan requirements that will come into effect April 1, 2015.  Specific issues that will need to be addressed are:

  • 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 within one 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.

Next Steps

With the new minimum coverage standards that will come into effect April 1, 2015, your group benefits representative will be working with you to review your plan, to ensure to ensure minimum standards are met. 

Drug Plan Details Continue to Develop

New Brunswick’s drug plan will continue to evolve over the next several months.  As an active member of the Canadian Life and Health Insurance Association (CLHIA), Sun Life will continue to monitor program developments and communicate when appropriate.  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.

Questions?

Contact your Sun Life Financial group benefits representative.