3.1(1)Entitled services that are provided in the Province or by a pharmacy outside the Province, but in Canada, shall be reimbursed under the programme.

3.1(2)Despite subsection (1), entitled services that are provided by a pharmacy outside Canada may be reimbursed under the programme if entitled services as defined in the Medical Services Payment Act are authorized under subsection 2(2) or (3) of that Act.

3.1(3)When an entitled service is provided outside the Province, the amount the beneficiary receives as reimbursement or the payment made on his or her behalf shall not exceed the amount that would have been reimbursed or paid if the entitled service had been provided in the Province.

4(1)A person shall be eligible to become a beneficiary

4(2)Notwithstanding subsection (1), on completion of registration with the department, the following persons shall be eligible to receive the entitled services as set out for those persons in the New Brunswick Prescription Drug Program Formulary:

4(3)A registration for a person who is suffering from human growth hormone deficiency shall include a written recommendation for treatment with the human growth hormone drug by an endocrinologist.

4(3.1)A registration for a person who is suffering from multiple sclerosis shall include a written prescription by a neurologist for treatment with a drug that is included in the Multiple Sclerosis Plan of the New Brunswick Prescription Drug Program Formulary.

4(4)A registration for an HIV-infected person shall include a written recommendation by a designated medical practitioner for treatment with Azidothymidine or any antiretroviral agent used only for the treatment of HIV-infected persons.

4(5)A registration for a person described in paragraph (2)(e) shall include a letter from the person who makes the determination, specifying the drug or drugs which the person is entitled to receive.

5(1)Subject to the Act and this Regulation, every beneficiary is eligible to receive reimbursement or have payment made on his behalf at the rate payable by the programme for or with respect to entitled services received by the beneficiary on and after October 1, 1975, in accordance with the Act and this Regulation.

5(2)No beneficiary is eligible to receive reimbursement or have payment made on his or her behalf for the cost of any entitled service in respect of which the beneficiary is eligible to receive reimbursement or have payment made on his or her behalf under any contract or plan of insurance.

5(4)When the human growth hormone drug is an entitled service, a beneficiary who is suffering from growth hormone deficiency may receive reimbursement or have payment made on his or her behalf for the drug only if the beneficiary is registered with the department as suffering from this deficiency.

5(5)Where the drug Azidothymidine or any antiretroviral agent used only for the treatment of HIV-infected persons is an entitled service, no beneficiary is eligible to receive reimbursement or have payment made on the beneficiary’s behalf for the drug Azidothymidine or any antiretroviral agent used only for the treatment of HIV-infected persons unless that beneficiary is registered with the department as an HIV-infected person and receives the drug from Regional Health Authority 3 / Régie régionale de la santé 3.

7(1)The following persons, whether residents or not, are not beneficiaries:

7(2)A person mentioned in paragraph (1)(a) shall upon discharge be eligible to become a beneficiary if the person shall, in the opinion of the Director, establish residence in the Province and apply within thirty days of establishing residence for coverage by the Medicare Branch.

7(3)A person mentioned in subparagraph (1)(b)(i) or (ii) shall be entitled to become a beneficiary as of the date of arrival in Canada if the person shall, in the opinion of the Director, establish residence within the Province and apply within thirty days of establishing residence for coverage by the Medicare Branch.

7.2(1)A person who applies to be designated a beneficiary and a person who is a beneficiary shall provide the Director, at the Director’s request, with such information, material or proof of any fact that is required by the Director to enable the Director to determine the person’s eligibility or continuing eligibility.

7.2(2)A person who is a beneficiary described in subparagraph 2.1(c)(iii) shall, as a condition of continuing eligibility, provide to the Director annually, within the month preceding the date of admission to the programme, such information, material or proof of any fact required by the Director to determine the person’s continuing eligibility and the authorized charges to be paid by or on behalf of the beneficiary.

8(1)A beneficiary shall register with the Medicare Branch on a registration form provided by the Medicare Branch for that purpose, or be registered by a person acting on that person’s behalf in order to become a beneficiary.

8(2)A person referred to in subparagraph (a)(ii) and paragraphs (b) and (c) of the definition “beneficiary” shall register or be registered by a person acting on behalf of that person, with the department in order to become a beneficiary.

8(3)A beneficiary suffering from cystic fibrosis or juvenile or infantile sclerosis of the pancreas is entitled to receive only those entitled services listed in the New Brunswick Prescription Drug Program Formulary as entitled services for persons suffering from cystic fibrosis or juvenile or infantile sclerosis of the pancreas.

8(4)A beneficiary who is a solid organ transplant recipient is entitled to receive only those entitled services listed in the New Brunswick Prescription Drug Program Formulary as entitled services for a solid organ transplant recipient.

8(6)A beneficiary suffering from human growth hormone deficiency is entitled to receive only those entitled services listed in the New Brunswick Prescription Drug Program Formulary as entitled services for persons suffering from human growth hormone deficiency.

8(7.1)A beneficiary suffering from multiple sclerosis is entitled to receive only those entitled services listed in the New Brunswick Prescription Drug Program Formulary as entitled services for persons suffering from multiple sclerosis.

8(8)A beneficiary who is an HIV-infected person is entitled to receive only those entitled services listed in the New Brunswick Prescription Drug Program Formulary as entitled services for HIV-infected persons.

8(9)Where the drug Azidothymidine or any antiretroviral agent used only for the treatment of HIV-infected persons is an entitled service for a beneficiary who is an HIV-infected person, the drug shall be obtained only from Regional Health Authority 3 / Régie régionale de la santé 3.

8(10)A person who is determined to be a beneficiary by the Minister or by a person authorized in writing by the Minister to make such determination is entitled to receive only those entitled services listed in the New Brunswick Prescription Drug Program Formulary as entitled services for such beneficiaries.

8(11)Notwithstanding subsection (10), a beneficiary referred to in subsection (10) may receive only the drug or drugs specified in the letter referred to in subsection 4(5) that accompanies that person’s registration with the department.

8(12)When a beneficiary has registered in accordance with this Regulation, a Prescription Drug Programme Identification Card bearing the beneficiary’s programme identification number shall be issued to the beneficiary.

8(13)A beneficiary requesting entitled services or a person acting on behalf of the beneficiary shall produce and show to the participating provider to whom the request is made, the card referred to in subsection (12).

8.1(1)The Minister may determine for each class of beneficiary the entitled services which each class of beneficiary is eligible to receive.

8.1(2)The Minister shall set out in the New Brunswick Prescription Drug Program Formulary, for each class of beneficiary, the entitled services which each class of beneficiary is eligible to receive.

12(2)A physician may be designated as a participating provider when, in the opinion of the Director, the location of other participating providers precludes reasonable access to entitled services for a number of beneficiaries.

12(4)A participating provider may, subject to the terms of an agreement with the Minister, elect to opt out of the programme by notifying the Minister in writing of this election.

12.1(1)Subject to subsection 12.2(2), the maximum allowable price is determined by multiplying the price per unit of the product specified by the Minister by the number of units dispensed.

12.1(2)For the purposes of subsection (1), the price per unit of a single source product is the price fixed by the Minister.

12.1(3)For the purposes of subsection (1), the price per unit of an interchangeable pharmaceutical product is the price fixed as follows:

12.2(1)For the purpose of subsection 2.1(1.1) or (1.3) of the Act and subject to subsection (2), the conditions are as follows:

12.2(2)The Minister may vary the maximum allowable price of an interchangeable pharmaceutical product and the conditions in subsection (1) in the following circumstances:

14(1)Where a non-participating pharmacy provides an entitled service to a person who is a beneficiary the pharmacist shall, before providing the entitled service, inform or cause to be informed the beneficiary that the pharmacy is non-participating and the pharmacist shall, after providing the entitled service, furnish the person such information as is prescribed in subsection (2) to enable the person to make a request for reimbursement under the programme with respect to the service provided.

14(2)The information required under subsection (1) is as follows:

14(3)Where an entitled service is provided in accordance with subsection (1), the amount that is payable for the entitled service under the programme shall be paid directly to the beneficiary but shall not exceed the amount as established by this Regulation as the amount payable for the entitled service.

14(4)Where a participating provider has a reasonable doubt as to the eligibility of the person or as to whether the drug prescribed is an entitled service under the programme, nothing shall prevent such participating provider from charging the person for the service to the limit of the amount laid down by this Regulation, in which case the person may make a request for reimbursement under the programme.

14(5)Notwithstanding any other section of this Regulation, the Director may, if it is considered appropriate to do so, make payments directly to organizations or persons acting on behalf of beneficiaries and such payments shall be made in accordance with this Regulation and shall not exceed the amounts provided hereunder.

14(6)Notwithstanding subsection (1), where a non-participating pharmacy provided an entitled service to a beneficiary, the Director may, in his sole discretion, accept from the beneficiary a request for reimbursement even though some of the information set out in subsection (2) has not been provided.

14(7)Notwithstanding the provisions of this section, where a non-participating provider provides an entitled service to a beneficiary, the Director may, in his sole discretion, accept from the provider an account for services rendered to the beneficiary and make payment in the amounts allowed by this Regulation directly to the provider even though some of the information set out in section 13 has not been provided.

14(8)Any payment made pursuant to subsection (7) shall be in lieu of making payment to the beneficiary.

15(1)A participating provider shall charge a beneficiary for each entitled service provided to the beneficiary as follows:

15(1.1)Nothing in this section prevents a participating provider from refunding a beneficiary the amount, or a portion of the amount, referred to in subsection (1).

15(2)If a beneficiary makes a request for reimbursement under the programme under section 14, an amount equal to the amount required to be charged under subsection (1) for each entitled service shall be deducted from the amount of the reimbursement, if any.

15(3)Where a beneficiary described in subparagraph (a)(i) of the definition “beneficiary” has paid more than five hundred dollars as provided under subsections (1) and (2) in any calendar year, the Director shall reimburse the beneficiary for any amounts paid in excess of five hundred dollars.

15(3.1)Subject to subsection (3.2), where a beneficiary described in paragraph (b) or (c) of the definition “beneficiary” has paid more than five hundred dollars as provided under subsections (1) and (2) in any calendar year, the Director shall reimburse the beneficiary for any amounts paid in excess of five hundred dollars.

15(3.2)Where there is more than one beneficiary described in paragraph (b) or (c) of the definition “beneficiary” within a family unit and those beneficiaries have paid in total more than five hundred dollars as provided under subsections (1) and (2) in any calendar year, the Director shall reimburse the person who has primary responsibility for the family unit for any amounts paid in excess of the total of five hundred dollars.

15(3.3)Notwithstanding subsections (1) and (2), a beneficiary who is a resident of a nursing home as defined in the Nursing Homes Act is exempt from the payment of the charges under subsections (1) and (2).

15(4)Notwithstanding subsections (3), (3.1) and (3.2), a beneficiary shall not be reimbursed for an amount less than one dollar.

15(5)This section does not apply to a person who is a beneficiary described in subparagraph 2.1(c)(iii).

15.001(1)In this section

15.001(2)A beneficiary described in subparagraph 2.1(c)(iii) shall, with respect to entitled services received by him or her under the programme, pay the monthly authorized charge in respect of the entitled services as calculated in accordance with the formula set out in Schedule 6.

15.001(3)Where a beneficiary pays more than the annual authorized charge in a year, the Director shall reimburse the beneficiary for the amount paid in excess of the annual authorized charge, except that an amount of one dollar or less shall not be reimbursed.

15.001(4)A person described in subparagraph 2.1(c)(iii) is not eligible to have any payment made on his or her behalf in respect of the drugs to which he or she would otherwise be entitled if the net disposable income of the family unit exceeds one hundred thousand dollars.

16(1)Subject to subsection (3), payment for an entitled service when rendered by a pharmacy is the sum of the following amounts:

16(3)If the entitled service rendered by a pharmacy is an interchangeable pharmaceutical product specified by the Minister, the payment for the service is the sum of the following amounts:

16(4)Despite subsections (1) and (3),

16(5)Subject to subsection (6), a dispensing fee under this section shall be paid to a pharmacy in the following circumstances:

16(6)In the case of a drug specified by the Minister that is classified according to the anatomical therapeutic chemical classification system, a dispensing fee shall be paid to a pharmacy in the following circumstances:

20.1(1)Where a prescription is for an entitled service that is an interchangeable pharmaceutical product specified by product name and the prescriber has not prohibited substitution and the participating provider elects to substitute an interchangeable pharmaceutical product other than the one specified in the prescription, the participating provider shall advise the beneficiary that an interchangeable pharmaceutical product other than the one specified in the prescription will be dispensed under the programme unless the beneficiary does not wish to receive the substituted interchangeable pharmaceutical product.

20.1(2)Where the beneficiary does not wish to receive the substituted interchangeable pharmaceutical product referred to in subsection (1), the participating provider

20.2(1)Where a prescription is for an entitled service that is an interchangeable pharmaceutical product not specified by product name, a participating provider shall, upon selecting an interchangeable pharmaceutical product to dispense, advise the beneficiary that the interchangeable pharmaceutical product selected by the participating provider will be dispensed under the programme unless the beneficiary does not wish to receive the selected interchangeable pharmaceutical product.

20.2(2)Where the beneficiary does not wish to receive the selected interchangeable pharmaceutical product referred to in subsection (1) and wishes to receive a different interchangeable pharmaceutical product, the participating provider

20.3(1)For the purposes of subsections 20.1(2) and 20.2(2), the authorized charge is 100 per cent or less of the difference between

22(1)Subject to subsection (3), payment for an entitled service when rendered by a dispensing physician is the sum of the following amounts:

22(3)If the entitled service rendered by a dispensing physician is an interchangeable pharmaceutical product specified by the Minister, the payment for the service is the sum of the following amounts:

22(4)Despite subsections (1) and (3), if the entitled service rendered by a dispensing physician is an extemporaneous preparation, the payment for the service is the sum of the following amounts:

22(5)Subject to subsection (6), a dispensing fee under this section shall be paid to a dispensing physician in the following circumstances:

22(6)In the case of a drug specified by the Minister that is classified according to the anatomical therapeutic chemical classification system, a dispensing fee shall be paid to a dispensing physician in the following circumstances:

23.01(1)For the purposes of subsection 3.1(1) of the Act, a claim by a participating provider shall be accompanied by the information as provided for in the pharmacy claim standard of the Canadian Pharmacists Association.

23.01(2)A participating provider shall submit a claim under section 13 in electronic format within three months after the date an entitled service was provided to a beneficiary or in non-electronic format within one year after the date an entitled service was provided to a beneficiary.

23.02(1)A participating provider may request a reassessment of a claim by resubmitting the claim in electronic format within three months after the date the entitled service was provided to the beneficiary or in non-electronic format within one year after the date an entitled service was provided to the beneficiary.

23.02(2)The Minister may conduct a reassessment of a claim and adjust the amount that he or she is required to pay to a participating provider if an error or omission exists with regard to the claim.

26(1)The following definitions apply in this section.

26(2)A person is not entitled to reimbursement or payment under the programme in respect of a prescription where the amount of the drug supplied exceeds a hundred day supply.

26(3)Notwithstanding subsection (2), a person is not entitled to reimbursement or payment under the programme in respect of a prescription for benzodiazepine, a narcotic or a controlled drug where the amount of the benzodiazepine, narcotic or controlled drug supplied exceeds a thirty-five day supply.

26(3.1)Notwithstanding subsection (2), if the amount of a drug supplied at any one time exceeds a thirty-five day supply, a person is not entitled to reimbursement or payment under the programme in respect of a prescription for a drug that is included in the Multiple Sclerosis Plan of the New Brunswick Prescription Drug Program Formulary.

26(4)A person is not entitled to reimbursement or payment under the programme for a drug dispensed under a prescription that is more than twelve months old.

27(1)All entitled services for which a claim is submitted under the programme shall be invoiced as listed in the New Brunswick Prescription Drug Program Formulary as follows:

27(2)All quantities shall be stated in the metric system.

28(1)Extemporaneous preparations that are prescribed by a physician or dentist and compounded by a pharmacist and that do not duplicate the formulation of a manufactured drug product may be determined to be entitled services under subsection 2.1(1) of the Act.

28(2)A participating provider shall not issue or cause to be issued or display or cause to be displayed any form of advertisement respecting the programme other than displays or advertising issued by the programme.

29(1)The New Brunswick Pharmacists’ Association may, by giving three months prior notice, request the Minister to meet with its representatives before July 1, 1988 and at two year intervals after that date, and discuss any change it might propose with respect to the dispensing fee payable under the programme.

29(2)After receiving a request under this section, the Minister shall, at least forty days from the end of the period specified in subsection (1), meet with the New Brunswick Pharmacists’ Association and discuss the changes proposed.

29(3)The Director shall provide to the New Brunswick Pharmacists’ Association

29(4)Notwithstanding subsection (3), where the supplying of information under this section involves an expense to the department the Director shall, before supplying the information, inform the New Brunswick Pharmacists’ Association of the costs involved and if the Association then requests the information, the Director may charge an amount to cover the cost of supplying the information.

29(5)The New Brunswick Medical Society may, by giving three months prior notice, request the Minister to meet with its representatives before July 1, 1988 and thereafter at two year intervals, to meet and discuss any change it might propose with respect to the dispensing fee payable under the programme.

29(6)After receiving a request under this section, the Minister shall, at least forty days from the end of the period specified in subsection (1), meet with the New Brunswick Medical Society and discuss the changes proposed.

32.01(1)The Review Committee shall be composed of the following four members appointed by the Lieutenant-Governor in Council:

32.01(2)Members of the Review Committee shall be appointed for a term of up to three years and are eligible for reappointment for one additional term.

32.01(3)Despite the expiration of his or her term, a member shall continue to be a member until he or she is replaced.

32.01(4)If a member is unable or unwilling to perform his or her duties due to incapacity, incompetence, absence or for any other reason, that member may be removed as a member by the Lieutenant-Governor in Council and another shall be appointed in his or her place.

32.01(5)A vacancy on the Review Committee does not impair the capacity of the Review Committee to act.

32.01(6)A member of the Review Committee is entitled to be reimbursed for accommodation, meal and travel expenses reasonably incurred in connection with his or her duties in accordance with the Treasury Board travel policy guidelines, as amended.

32.02(1)The Review Committee shall meet as required at the call of the chair at the date, time and place designated by the chair.

32.02(2)Three members of the Review Committee constitute a quorum with at least one member being the chair.

32.02(3)All matters of decision shall be decided by majority vote and the chair shall not vote except to have a casting vote in the event of a tie.

32.02(4)Matters reviewed by the Review Committee and the deliberations of the Review Committee shall be held in confidence and, when possible, the Minister shall provide the Review Committee only with information that does not identify the participating provider.