Government of New Brunswick

Assessment and Prescribing for Shingles (Herpes Zoster) by Pharmacists

The assessment and prescribing for shingles (herpes zoster) by a pharmacist is eligible for coverage by the Department of Health effective June 6, 2022. Each patient is eligible for a maximum of one shingles assessment per one-year period.

This program does not cover the cost associated with the dispensing of drugs.

Eligibility


Assessment of herpes zoster, with or without prescribing, may be eligible for coverage provided all the following criteria are met

Patient

  • The patient presents with a herpes zoster rash.
  • The patient is aged 12 and older.
  • The patient must have a valid Medicare card and not reside in a nursing home.
  • A maximum of one (1) herpes zoster assessment PIN per patient within the past 12 months.

Pharmacist

  • The service is conducted in person by a pharmacist licensed with the NB College of Pharmacists (NBCP).
  • The pharmacist must comply with all applicable NBCP requirements and standards.

Prescription

  • If a drug is prescribed, it must be:
    • a Schedule 1 drug; and
    • 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 drug therapy for the treatment of herpes zoster must be listed as a benefit on the NB Drug Plans formulary.

Eligible Services and Fees


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 the herpes zoster assessment fees which have been paid for by the Department of Health. The applicable assessment fees are outlined below:

Table 1

Assessment Fee
Herpes Zoster Assessment that meets symptom criteria (results in a prescription) $20
Herpes Zoster Assessment that meets symptom criteria (results in a prescription and a referral to another health professional)  $20
Herpes Zoster Assessment that meets symptom criteria but does not result in a prescription $20
Herpes Zoster Assessment that does not meet symptom criteria $20

 

Claim Submission


Pharmacists must document how the patient meets the eligibility criteria for this policy, and if applicable which prescription was prescribed.

Pharmacists must document reason(s) for initiating treatment in patients that are at higher risk, including immunocompromised or with symptoms of complicated disease.

Claim Submission

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 M
Client ID Patient’s NB Medicare number.  (Note: this also applies to New Brunswick Drug Plans beneficiaries.)
Patient Code Leave Blank
Patient Name Patient’s first and last name
Patient DOB Patient’s date of birth
Prescriber ID New Brunswick College of Pharmacists Licence Number of the prescribing pharmacist.
Prescriber ID Reference Code 46
DIN / PIN Please refer to Table 2
Quantity 1
Days Supply 1
Drug Cost / Product Value Zero
Cost Upcharge Zero
Professional Fee Please refer to table 1

Table 2

 

PIN
Herpes Zoster Assessment that meets symptom criteria (results in a prescription) 06661234
Herpes Zoster Assessment that meets symptom criteria (results in a prescription and a referral to another health professional)
 06661235
Herpes Zoster Assessment that meets symptom criteria but does not result in a prescription 06661236
Herpes Zoster Assessment that does not meet symptom criteria 06661237

 

Pharmacy Audits


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