New Brunswick Drug Plan: Coverage for Seniors and Uninsured Residents

Overview of New Brunswick Prescription Drug Programs

The Government of New Brunswick provides drug coverage through several distinct plans tailored to different resident groups. The primary initiative is the New Brunswick Drug Plan, which covers prescription drugs for uninsured residents. A separate component is the New Brunswick Prescription Drug Program, which is specifically for seniors receiving the federal Guaranteed Income Supplement. These programs are supported by a formulary, which is the official list of over 5,000 prescription medications eligible for coverage. The plans do not cover items like vaccines, cannabis products, medical devices, or supplies such as diabetic equipment. The overarching goal is to reduce out-of-pocket spending on medications, which a 2021 study noted was the highest in Canada for low-income New Brunswickers. The program is administered in cooperation with Medavie Blue Cross for certain senior plans, and all plans require a valid New Brunswick Medicare card as a foundational eligibility criterion.

Detailed Eligibility Criteria and Exclusions

To qualify for the New Brunswick Drug Plan, an individual must be a resident of New Brunswick and hold a valid New Brunswick Medicare card. The plan is intended for those who do not have prescription drug coverage from any other source, such as a private group benefits plan. There are no denials based on age or pre-existing medical conditions, and once enrolled, there is no waiting period or deductible before benefits begin. The plan is designed to be accessible, with premiums calculated based on family income and size. Children who are 18 years of age or younger can be covered at no additional cost as long as at least one parent or guardian is enrolled in the plan. For seniors, eligibility for the specific New Brunswick Prescription Drug Program requires being aged 65 or older and receiving the Guaranteed Income Supplement. Some low-income seniors not on the GIS may also qualify, but they would typically enrol in the standard income-based Drug Plan or the Medavie Blue Cross program.

The New Brunswick Drug Plan serves eligible residents of New Brunswick who have a valid NB Medicare card. The plan is designed for uninsured New Brunswickers, which includes seniors. The New Brunswick Prescription Drug Program specifically helps people aged 65 or older who do not have other drug coverage. The Medavie Blue Cross Seniors' Prescription Drug Program is also available for uninsured New Brunswickers aged 65 or older.

• Uninsured New Brunswickers of any age needing drug coverage.
• Seniors aged 65 or older with no other drug plan.
• Seniors who receive the federal Guaranteed Income Supplement (GIS).
• Low-income seniors who do not receive the GIS may also qualify.
• New residents who have recently obtained NB Medicare.

To qualify for the New Brunswick Prescription Drug Program, seniors must not have coverage through another drug plan. The New Brunswick Drug Plan is for residents who do not have drug coverage. If you earn a lot of money and only need a prescription every once in a while, the New Brunswick Drug Plan might not be for you. The programs are intended for those with no other options for prescription drug coverage.

The Three Drug Coverage Programs for Seniors

Seniors in New Brunswick have access to three specific prescription drug coverage programs based on their income and circumstances. The first is the New Brunswick Prescription Drug Program for seniors who receive the federal Guaranteed Income Supplement. This program has no annual premium and charges a co-payment of $9.05 per prescription, with an annual personal spending cap of $500. The second option is the standard New Brunswick Drug Plan, which is available to uninsured seniors and uses an income-based premium and a 30 percent co-payment per prescription. The third option is the Medavie Blue Cross Seniors' Prescription Drug Program, which carries a monthly premium of $140 and a $15 co-pay per prescription. All seniors must be 65 or older, be permanent residents of New Brunswick, possess a valid Medicare card, and have no other drug coverage to be eligible for any of these plans. The provincial government proactively mails an application package to residents 60 days before their 65th birthday to facilitate enrolment into the appropriate plan. This package contains detailed eligibility information and the necessary application forms to begin the process.

Application Process, Deadlines, and Late Applications

The application process is initiated by the government for seniors, who receive a package in the mail 60 days before their 65th birthday. For the New Brunswick Prescription Drug Program linked to the Guaranteed Income Supplement, seniors can apply by contacting Service Canada at 1-800-227-9914. For the Medavie Blue Cross Seniors' Program, applying within 60 days of turning 65 is crucial as it ensures coverage becomes effective on the first day of the month of the 65th birthday. Applications submitted within 60 days after cancelling another drug plan also have coverage start on the first day of the month following the cancellation date. Late applications submitted after the 60-day window require the completion of a medical questionnaire for drug coverage, and acceptance is not guaranteed as it is based on medical history. Late applicants for the Medavie program also face a one-year waiting period for certain health benefits. If a late applicant is accepted, their prescription drug coverage becomes effective the first day of the month following the receipt of their application. Applications can be submitted by mail, fax, or email to the specified addresses for each program.

For the Medavie Blue Cross Seniors' Program, you must apply within 60 days after turning 65. If you apply within 60 days following your 65th birthday, coverage becomes effective on the first day of the month you turn 65. If you apply within 60 days following cancellation of another plan, coverage becomes effective on the first day of the month following the cancellation date. If you apply within 60 days after gaining eligibility for NB Medicare as a new resident, that is also a qualifying event.

1. Apply within 60 days of your 65th birthday: Coverage is effective the first day of the month you turn 65.
2. Apply within 60 days of cancelling another plan: Coverage is effective the first day of the month following the cancellation date.
3. Apply within 60 days of obtaining NB Medicare as a new resident: Coverage is effective as per the rules for new residents.
4. Apply as a late applicant (after 60 days): Must complete a medical questionnaire. Acceptance is not guaranteed. Drug coverage effective the first day of the month after application receipt.

If you did not apply within the 60 day limit, you may apply as a late applicant. Late applicants are required to complete a medical questionnaire for drug coverage. You may or may not be accepted based on your medical history. A one year waiting period will apply to late applicants for some Health Benefits. If you are a late applicant, your prescription drug coverage becomes effective the first day of the month following the receipt of your application.

Cost Structures and Financial Protections

The cost to participants varies significantly between the different drug plans. The New Brunswick Prescription Drug Program for GIS recipients has no premium, a fixed $9.05 co-pay, and a hard annual out-of-pocket maximum of $500 per person. The standard New Brunswick Drug Plan uses a sliding scale for monthly premiums based on family income, coupled with a co-payment of 30 percent of the drug cost per prescription. The Medavie Blue Cross Seniors' Program has a fixed monthly premium of $140 and a $15 co-pay per prescription, with no mentioned annual cap. These structures are designed to protect members from full drug price increases and to make costs predictable. Changes in a member's income or family structure can affect their premium amount in the income-based plan. The government describes the Drug Plan as operating like a private health plan but with income-based premiums to ensure affordability. A key feature is that the price for plan members is capped, so even if drug manufacturers raise prices, members will not be charged more than the plan's stipulated cost-sharing amounts. The plan is particularly beneficial for low-income earners with complex medical conditions who need to fill multiple prescriptions every month.

Optional Health Benefits with Medavie Blue Cross

Seniors enrolled in the Medavie Blue Cross Seniors' Prescription Drug Program have the option to purchase additional hospital, health, and dental coverage to create a more comprehensive plan. The hospital benefit covers 80 percent of the cost, up to $50 per day, for a semi-private or private hospital room, with a maximum of 90 days per year. A three-month waiting period applies for new enrollees before hospitalization coverage begins. Dental benefits are covered at 70 percent and include services like recall exams, polishing, scaling, fillings, root canal treatment, extractions, and minor denture repairs, subject to frequency limits and a six-month waiting period. Health coverage is offered in Basic and Enhanced plan options, both of which include an Accidental Death and Dismemberment benefit of $5,000, underwritten by Blue Cross Life Insurance Company of Canada. Late applicants for these add-on benefits are subject to a one-year waiting period for certain coverages if they did not apply within the 60-day window following their 65th birthday, termination of other benefits, or obtaining NB Medicare. These optional benefits are designed to complement the core drug coverage and help manage broader health costs.

Optional dental benefits are covered at 70 percent. These benefits include a recall exam, polishing, and scaling. They also include fillings, root canal treatment, and extractions. Furthermore, they cover minor denture repair, denture reline, and rebase. Frequency limits may apply for these dental services.

• Recall examination
• Polishing and scaling
• Fillings
• Root canal treatment
• Extractions
• Minor denture repair
• Denture reline and rebase

To complement your drug coverage, you can consider adding hospital coverage and health benefits. Health coverage offers Basic and Enhanced plan options. These optional benefits involve additional premiums and are separate from the core prescription drug coverage. All health benefits are subject to the late applicant waiting period rules if you do not apply on time.

Roles and Responsibilities for Healthcare Providers

Pharmacies and healthcare providers must be registered as participating providers with the New Brunswick Drug Plan before they can submit patient claims for reimbursement. The registration process requires completing the New Brunswick Drug Plans Participating Provider Agreement and a Direct Deposit Form for payment purposes. Providers must consult the plan's formulary to confirm which specific medications and services are covered benefits. For drugs not listed on the standard formulary, providers can initiate a special authorization request through the established channels. It is the responsibility of the provider to stay informed of updates to the plan by referring to the official Government of New Brunswick website, as changes to the formulary or policies can affect patient service. The plan provides a toll-free fax number, 1-888-455-8322, for provider communications. Providers are a trusted source of information for uninsured patients and can direct them to the plan and help them understand its benefits and application process. Healthcare professionals should understand how the plan works to effectively serve patients who need drug coverage.

Common Points of Confusion and Key Contacts

Several areas commonly cause confusion for applicants and members. A primary distinction is between the New Brunswick Drug Plan for the general uninsured population and the New Brunswick Prescription Drug Program for low-income seniors on GIS, which have different cost structures. The 60-day application deadline for the Medavie Blue Cross Seniors' Program is critical, as missing it leads to a late application process with medical underwriting. It is also important to understand that these programs cover prescription drugs only, excluding over-the-counter medications, medical supplies, and cannabis products. The plan is not designed for those with high incomes and minimal prescription needs, as the calculator tool suggests it may not be cost-effective for them. For general inquiries about the New Brunswick Drug Plan, the information line is 1-800-332-3692 and the fax number is 1-888-455-8322. For the Medavie Blue Cross Seniors' Program, the contact number is 1-844-209-7599 and the fax is 1-855-551-9984.

For the New Brunswick Drug Plan, you can call the NBDP info line at 1 800 332 3692. For the New Brunswick Prescription Drug Program, you can call Service Canada at 1 800 227 9914. For the Medavie Blue Cross Seniors' Program, you can telephone 1 844 209 7599. You can also fax forms for the New Brunswick Drug Plans to 1 888 455 8322.

• New Brunswick Drug Plan general inquiries: 1-800-332-3692
• New Brunswick Drug Plan provider fax: 1-888-455-8322
• Guaranteed Income Supplement (GIS) questions: Service Canada at 1-800-227-9914
• Medavie Blue Cross Seniors' Program: 1-844-209-7599
• Medavie Blue Cross Seniors' Program fax: 1-855-551-9984
• New Brunswick Drug Plan email: [email protected]
• Medavie Blue Cross Seniors' Program email: [email protected]

Using the correct contact number for your specific query can save time. The information on third party websites is for general knowledge only and is subject to change. You should always refer to the official Government of New Brunswick website for the most current details. Changes to the plans could affect how you serve your patients or access your benefits.

Frequently asked questions

Sources and further reading

1. Seniors' Prescription Drug Plans | New Brunswick benefitswayfinder.org
2. Navigating Seniors' Drug Coverage in New Brunswick opus-md.nbms.nb.ca
3. New Brunswick Drug Plan nblung.ca
4. New Brunswick Seniors Health Insurance medaviebc.ca

This article explains how things work and is not financial, tax or legal advice. Rules, limits and rates change, so check the current figures with the Canada Revenue Agency, your province or your financial institution before you act.