Out of Province Drug Subsidization coverage under the Newfoundland and Labrador Prescription Drug Program (NLPDP) extends coverage to beneficiaries who hold a valid NLPDP card and have been referred out of province for medical treatment. Beneficiaries may have the cost of their outpatient medications covered provided the medications are identified and authorized by this Department. Out of Province Drug Subsidization coverage is managed by the Assessment Office.
Prior Approval
To obtain authorization for payment of out of province claims the department will require confirmation of the referral out of province for medical reasons by a physician of this province.
Arrangements should then be made, preferably with the Hospital Pharmacy to which the beneficiary was referred, to provide the following information:
- The patient’s name,
- NLPDP card number,
- Drug Identification Number (DIN),
- Drug name,
- Quantity dispensed,
- Date dispensed, and
- Cost
It is in the best interest of the beneficiary, if the Department can be provided with a list of medications which may be required before and after the medical procedure/treatment. The list can be reviewed by Pharmaceutical Services noting the medications requiring special authorization or those that are not benefits of the program. When prior approval is requested, the beneficiary can be provided with special authorization forms should any of these medications be necessary. This will avoid delays in coverage for the beneficiary.
NLPDP does not provide coverage for cancer chemotherapy and anti-rejection medications. There is an interprovincial agreement in place where there is coverage of these medications while the resident is out of province for medical treatment. A resident of Newfoundland and Labrador, in receipt of a valid Medical Care Plan (MCP) card, will be provided the necessary medications for in-hospital chemotherapy (cancer only) and anti-rejection therapy (transplant). The hospital will invoice the host jurisdiction’s Ministry of Health which will in turn bill the Newfoundland and Labrador Department of Health and Community Services. The medications provided under this agreement are:
- Chemotherapy
- Cyclosporine
- Retrovir / Zidovudine / AZT
- Alteplase / Activase
- Prograf / Protopic / Tacrolimus
- Eprex / Erythropoietin
- Growth Homone Therapy
Continuation of cancer chemotherapy and anti-rejection medications will be provided by the Eastern Regional Health Authority once the resident has returned to Newfoundland and Labrador. To access these medications, a resident can call (709) 777-6245.
Exception to policy
Exception to the Out of Province Drug Subsidization policy is considered for beneficiaries who, while out of province for travel or non-medical purposes, experience a medical emergency requiring hospitalization and new medications. In order to obtain a reimbursement for the new medications, the beneficiary must submit the following:
- Original prescription receipts noting NLPDP ID number, and
- Documentation of hospitalization noting the medical emergency.
Medical emergencies considered for reimbursement under the NLPDP include but are not limited to:
- heart attack
- stroke
- accident resulting in bodily injury
- cancer
- other medical conditions as approved by the Pharmaceutical Services Division.