ORGAN TRANSPLANT PLAN by tyndale

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									    NEW
 BRUNSWICK
PRESCRIPTION
    DRUG
  PROGRAM




  ORGAN
TRANSPLANT
   PLAN



 Prescription Drug Program   Programme de médicaments sur ordonnance
 P.O. Box 690                C.P. 690
 Moncton, New Brunswick      Moncton (Nouveau-Brunswick)
 Canada E1C 8M7              Canada E1C 8M7
 Tel: (506) 867-4515         Téléphone : (506) 867-4515
 Fax: (506) 867-4872         Télécopieur : (506) 867-4872              BRO-065 05/05
The New Brunswick Prescription Drug
Program (NBPDP) Organ Transplant
Plan provides coverage for anti-rejection
prescription drugs* to New Brunswick
residents who receive a solid organ or bone
marrow transplant.

This brochure outlines how to pre-register/
enrol for benefits. If you have any questions,
please do not hesitate to call 1-800-332-3692.

Please follow these steps to determine your
eligibility for benefits:
1. Once you have been notified that your
   name is on the active waiting list for a
   transplant, contact the New Brunswick
   Organ Procurement Officer at
   (506) 643-6848.
2. Complete and return the attached
   application form to NBPDP. The address
   is listed at the top of the enclosed form.

You will be notified that your application
form has been processed. If you are eligible
you will be informed what your monthly co-
payment* will be. However, you will not
be able to obtain prescriptions until your
transplant has been completed. You may
also have to pay a registration fee*.
3. Immediately following your transplant,
   you or your family should contact the
   Organ Procurement Officer at (506) 643-
   6848. Upon receipt of your registration
   fee, if applicable, your application will
   be activated and your prescription drug
   card will follow in the mail.
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When filling your anti-rejection medication
prescriptions at your local pharmacy, show
your prescription drug card and the majority of
the prescription cost will be paid directly to the
pharmacy. However, you will be required to
make a co-payment for each prescription.
Depending on the quantity of medication
prescribed by your physician, you may obtain
up to a three month supply at one time.

If you are prescribed a drug that is not covered
under this plan, you may apply for coverage of
that drug through the Special Authorization*
process. The drug must be directly related to your
transplant condition and must be requested in
writing by your physician (e.g., Cellcept).

NBPDP will reimburse eligible anti-rejection
medication in the Province where your opera-
tion was performed, for a maximum period of
sixty days from the date of your transplant.

Coverage under this plan is for a 12-month
period. The renewal date is July 1 of each
year. Two months prior to that date, an enroll-
ment renewal package will be automatically
forwarded to you. Your renewal package
should be completed and returned to NBPDP
by July 1.

For more information on the NBPDP
Organ Transplant Plan, please contact the
New Brunswick Prescription Drug Pro-
gram Inquiry Line at 1-800-332-3692
within NB or 1-506-867-4515 outside NB.
*See Definitions, pages 5 and 6.
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ELIGIBILITY CHART
                                                             Can you apply Will you be able to How Much is the         How much is the
                                                              for benefits? access the Special  Registration            Co-payment?(2)
                                                                                Authorization (SA)       Fee?(2)
                                                                                    Process?

    No Insurance: You are not cur-                                   YES               YES                $50            20% of
                                                                                                                    prescription cost,
    rently covered by an insurance plan                                                                                  up to a
    for prescription drugs.                                                                                         maximum of $20.
    Private Insurance – Full Coverage:                                NO         Not Applicable      Not Applicable  Not Applicable
    You have a private plan for
    prescription drugs that includes anti-
    rejection medications.(1)
    Private Insurance – Limited                                      YES              YES                 $50              20% of
    Coverage: You have a private plan                                            Only for anti-                       prescription cost,
    for prescription drug coverage but it                                          rejection                               up to a
    does not cover anti-rejection medica-                                         medication                          maximum of $20.
    tion. Please include a letter from your
    private insurance carrier. This letter
    will be required annually.
    Family & Community Services (FCS)                                YES               NO                  $0         Identical to your
    Health Card: You have a health card                                            (SA process                        FCS health card.
    for prescription drugs through the                                          already available                         (i.e. $4)
    Department of Family & Community                                                under FCS
    Services (FCS).                                                                Health Card)
    NB Prescription Drug Seniors                                     YES               NO                  $0         Identical to your
    Program: You are 65 years of age or                                            (SA process                        NBPDP Seniors’
    older and have qualified for prescrip-                                      already available                        Drug Plan.
    tion drug coverage because you are                                               under the
    receiving the Guaranteed Income                                             NBPDP Seniors’
    Supplement or you have qualified                                                Drug Plan.)
    through a Declaration of Income.
    Medavie Blue Cross Seniors                                       YES               NO                 $50              20% of
    Health Program: You are 65 years                                               (SA process                        prescription cost,
    of age or older and you have pre-                                           already available                          up to a
                                                                                    under your
    scription drug coverage through the                                                                               maximum of $20.
                                                                                  Medavie Blue
    Medavie Blue Cross Seniors’ Health                                           Cross Seniors’
    Program.                                                                    Health Program.)
1
    If your plan stipulates a lifetime maximum amount, you may be eligible to
    receive anti-rejection benefits through the NBPDP. Please contact
    1-800-332-3692 for more information.
2
    See Definitions, pages 5 and 6.
                                  -3-                                                                           -4-
             DEFINITIONS

Anti-rejection drugs: Specific strengths
and formulations of the following anti-
rejection medications are covered by the
NBPDP Organ Transplant Plan:

  Cyclosporine (Neoral®)
  Tacrolimus (Prograf ®)


Special Authorization: Through the Special
Authorization process, you may be eligible
for coverage for non-benefit drugs that
directly relate to your medical condition as a
result of your organ transplant. A written
request from an attending physician is
required. Information should include:
· Patient’s Medicare number
· Patient’s date of birth
· Drug, dosage, form and strength
· Expected duration of therapy
· Specific clinical and diagnostic evidence
    supporting the use of the medication


Co-payment: This is the percentage of the
cost you are required to pay when filling a
prescription at your local pharmacy. See the
Eligibility Chart on pages 3 and 4 to deter-
mine your co-payment.




                     -5-
Registration Fee: There is a $50 annual fee
required to obtain coverage for a one-year
period beginning July 1 of each year. In the
first year, this fee is pro-rated to reflect the
individual’s personal enrollment period (i.e.,
you will only pay for those months remain-
ing in the year from the time you receive
coverage). Please refer to the chart below to
determine your first-year registration fee.

Month of Transplant        Registration Fee
          July                 $ 50.00
         August                $ 45.87
       September               $ 41.70
        October                $ 37.53
       November                $ 33.36
       December                $ 29.19
        January                $ 25.02
        February               $ 20.85
         March                 $ 16.68
          April                $ 12.51
          May                  $ 8.34
          June                 $ 4.17


Please ensure registration fee is made
payable to:
New Brusnwick Prescription Drug Pro-
gram.




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NOTES




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