Bill 27 - Prescription and Catastrophic Drug Insurance Act

BILL 27

Prescription and Catastrophic Drug Insurance Act

Her Majesty, by and with the advice and consent of the Legislative Assembly of New Brunswick, enacts as follows:

PART 1

DEFINITIONS AND INTERPRETATION

Definitions

1 The following definitions apply in this Act.

“benefit” means an entitled service that is provided to a member of the Plan or the reimbursement to a member of the Plan of the cost or a portion of the cost of an entitled service. (prestations)

“dependant” means a person without a spouse who is (personne à charge)

(a) under 19 years of age and is dependent for support on a parent or guardian, or

(b) a person with a disability.

“drug” means a substance or combination of substances used or intended to be used to diagnose, treat, mitigate or prevent a disease, disorder or abnormal physical or mental state, or a symptom of them, or to restore, correct or modify organic functions in people. (médicament)

“entitled person” means an entitled person as defined in the Medical Services Payment Act. (personne admissible)

“entitled service” means a drug, good or service that is determined by the Minister to be an entitled service under the Plan. (service assuré)

“family unit” means a member of the Plan and the following entitled persons: (unité familiale)

(a) the member’s spouse, and

(b) dependants of the member or of the member’s spouse who reside with the member.

“income” means the total income in the year immediately preceding the current year as declared on Line 150 of an individual’s income tax return or notice of assessment. (revenu)

“insurer” means an insurer licensed under the Insurance Act or an individual or a corporation that self-insures residents of the Province under a private group drug insurance contract but excludes an individual or a corporation that provides group drug coverage under an Act of the Legislature, an Act of another province or territory of Canada or an Act of the Parliament of Canada. (assureur)

“Minister” means the Minister of Health and includes any person designated by the Minister to act on the Minister’s behalf. (ministre)

“person with a disability” means a person who is 19 years of age or over, is eligible for a Disability Tax Credit under the Income Tax Act (Canada), was eligible for the tax credit as a minor and resides with a parent or guardian. (personne atteinte d’une limitation fonctionnelle)

“personal health information” means personal health information as defined in the Personal Health Information Privacy and Access Act. (renseignements personnels sur la santé)

“personal information” means personal information as defined in the Right to Information and Protection of Privacy Act. (renseignements personnels)

“pharmacist” means (pharmacien)

(a) a person who holds a valid pharmacist’s licence under the Pharmacy Act, or

(b) a person who provides entitled services in a jurisdiction outside the Province and is licensed to practise pharmacy in that jurisdiction.

“pharmacy” means a place of business (pharmacie)

(a) that holds a valid certificate of accreditation under the Pharmacy Act, or

(b) that operates outside the Province and is licensed or accredited as a pharmacy in that jurisdiction.

“Plan” means the Drug Insurance Plan established under section 3. (régime)

“premium” means an annual amount paid by each member of the Plan, other than a dependant or a person excluded by regulation. (prime)

“provider” means a pharmacist who practises in the Province, any other health care professional prescribed by regulation who practises in the Province or a pharmacy that operates in the Province. (dispensateur)

“spouse” means, in relation to any person, (conjoint)

(a) a person to whom that person is married, or

(b) a person with whom that person cohabits in a conjugal relationship and

( i) who has cohabited continuously with that person for at least one year,

( ii) who is the parent of that person’s child, or

( iii) who has custody and control of that person’s child or who had custody and control of that person’s child before the child turned 19 years of age if the child is dependent on him or her for support.

Conflict

2( 1) If a conflict exists between a provision of this Act or of any regulation made under this Act, and a provision of the Insurance Act or of any regulation made under that Act, the provision of this Act or of the regulation made under this Act prevails.

2( 2) If a conflict exists between a provision of this Act or of any regulation made under this Act, and a provision of the Right to Information and Protection of Privacy Act or of any regulation made under that Act, the provision of this Act or of the regulation made under this Act prevails.

PART 2

GOVERNANCE

Establishment of Drug Insurance Plan

3 There is established a Drug Insurance Plan for the purpose of ensuring that entitled persons have reasonable and fair access to prescription drugs.

Loss of entitlement

4 Despite the Medical Services Payment Act, a person who establishes permanent residence outside the Province is not an entitled person for the purposes of this Act, commencing on the date he or she leaves the province.

Insurance Act not applicable

5 The Insurance Act does not apply to the Plan.

Appointment of Director

6( 1) The Minister shall appoint an employee of the Civil Service, as defined in the Civil Service Act, as Director of the Plan.

6( 2) The Director shall exercise the powers and perform the duties imposed on the Director under this Act and the regulations.

6( 3) The Director may access any database or information system of the Minister for the purpose of exercising or performing his or her powers or duties under this Act and the regulations.

6( 4) The Director may collect from and disclose to the Medicare Branch of the Department of Health the personal information and personal health information prescribed by regulation relating to an entitled person.

6( 5) The Director may designate one or more persons to act on the Director’s behalf.

Appointment of Plan Administrator

7 The Minister shall appoint a Plan Administrator to exercise the powers and perform the duties imposed on the Plan Administrator under this Act and the regulations.

Agreements

8( 1) The Minister may enter into agreements with any organization, agency, person or Minister of the Crown or with the government of a province or territory of Canada or the Government of Canada if the Minister considers the agreements necessary or expedient for the administration of this Act.

8( 2) The Minister may, for the purposes prescribed by regulation, enter into agreements with the Canada Revenue Agency or an entity prescribed by regulation to collect, use or disclose personal information or personal health information.

Policies and guidelines

9( 1) The Minister may establish provincial policies and guidelines related to the administration of the Plan.

9( 2) A policy or guideline established under subsection (1) shall be published by the Minister as soon as practicable on the Department of Health website.

9( 3) The Regulations Act does not apply to provincial policies and guidelines established under subsection (1).

Advisory Committee

10( 1) There is established a Drug Insurance Plan Advisory Committee consisting of members appointed by the Minister.

10( 2) The Advisory Committee shall advise and make recommendations to the Minister on matters referred to the Advisory Committee by the Minister, including

(a) financial matters prescribed by regulation,

(b) policy and other matters related to the Plan,

(d) any other matter prescribed by regulation.

10( 3) The members of the Advisory Committee may access Plan information for the purpose of exercising their powers or performing their duties under this Act or the regulations.

10( 4) For the purpose of subsection (3), Plan information that contains personal information or personal health information shall be de-identified before it is accessed by members of the Advisory Committee.

Experts

11 The Minister or the Advisory Committee may engage experts to advise the Minister or the Advisory Committee on any matter related to this Act.

PART 3

EARLY ENROLMENT

Voluntary membership

12( 1) From April 1, 2014, to March 31, 2015, both dates inclusive, an entitled person may apply to the Director to become a member of the Plan under this section on a form provided by the Minister accompanied by the information prescribed by regulation.

12( 2) The Director may grant membership in the Plan to an entitled person referred to in subsection (1) from May 1, 2014, to March 31, 2015, both dates inclusive.

12( 3) A dependant shall not become a member of the Plan under subsection (2) unless an adult who is an entitled person and a member of the dependant’s family unit becomes a member of the Plan.

12( 4) An entitled person shall not become a member of the Plan under subsection (2) if the entitled person has drug coverage under

(a) an Act of the Legislature other than this Act, an Act of another province or territory of Canada or an Act of the Parliament of Canada, or

(b) a program administered by a government, a department or an agency.

12( 5) Despite subsection (4) and subject to subsection (6), an entitled person who is a beneficiary under the Prescription Drug Payment Act may become a member of the Plan under subsection (2).

12( 6) An entitled person who is a beneficiary under the Prescription Drug Payment Act, excluding a beneficiary under paragraphs 2.1(b) to (d) of New Brunswick Regulation 84-170 under that Act, may become a member of the Plan under subsection (2) if he or she ceases coverage under that Act.

12( 7) The Director shall send a notice of membership in the Plan to an entitled person who becomes a member of the Plan under this section at his or her latest known address.

12( 8) If the Director does not grant membership in the Plan to an entitled person under subsection (2), the Director shall send a notice to the person at his or her latest known address that includes reasons for the denial and the person’s right to appeal.

Information provided by an entitled person

13( 1) From April 1, 2014, to March 31, 2015, both dates inclusive, the Director may require that an entitled person provide, on behalf of a dependant, proof that the dependant is a person with a disability.

13( 2) On request of the Director, an entitled person shall provide the Director the information prescribed by regulation within the time prescribed by regulation.

13( 3) An entitled person shall provide the Director with a written statement that includes the information prescribed by regulation when the entitled person becomes a member of the Plan.

13( 4) If an entitled person fails to provide the required information under this Act and the regulations, the Director may deny coverage under the Plan or a benefit to the member of the Plan or to any dependant who is part of the member’s family unit.

Maintaining private drug insurance

14( 1) From May 1, 2014, to March 31, 2015, both dates inclusive, a member of the Plan who maintains one or more private drug insurance contracts is only entitled to a benefit if

(a) the contracts do not provide any coverage for the entitled service, or

(b) the member has reached the annual or lifetime maximum coverage under the contracts.

14( 2) This section applies despite any agreement to the contrary between an insurer and an insured.

Premiums for voluntary members

15( 1) An entitled person who becomes a member of the Plan under section 12 shall pay the premium set by regulation to the Plan Administrator within the time and in the manner prescribed by regulation.

15( 2) The Plan Administrator may reimburse any overpayment of premiums if a member of the Plan referred to in subsection (1) applies for a reimbursement within the time and in the manner prescribed by regulation.

PART 4

MEMBERS OF THE PLAN

Definition of “qualifying private individual drug insurance contract”

16 In this Part, “qualifying private individual drug insurance contract” means a private individual drug insurance contract that meets the requirements under paragraphs 40(a) and (f) applicable to private group drug insurance. (contrat admissible d’assurance médicaments privée individuelle)

Certificate of private individual drug insurance

17 An insurer who has entered into a qualifying private individual drug insurance contract shall provide a certificate of insurance to each person insured under the contract that contains the information prescribed by regulation on or before April 1, 2015, or on or before the effective date of the coverage.

Mandatory membership

18( 1) A person who is an entitled person on April 1, 2015, becomes a member of the Plan on April 1, 2015, and a person who subsequently becomes an entitled person becomes a member of the Plan on the date the person becomes an entitled person.

18( 2) The Director shall send a notice of membership in the Plan to an entitled person who becomes a member of the Plan under this section at his or her latest known address.

18( 3) An entitled person shall apply to the Director for an exemption from the Plan within 30 days after receiving a notice of membership or within 30 days after becoming eligible for an exemption if the entitled person has drug coverage

(a) under a private group drug insurance contract,

(b) under a qualifying private individual drug insurance contract,

(c) under an Act of the Legislature other than this Act, an Act of another province or territory of Canada or an Act of the Parliament of Canada that is at least equivalent to the coverage of the Plan,

(d) under a program administered by a government, a department or an agency that is at least equivalent to the coverage of the Plan, or

(e) as prescribed by regulation.

18( 4) Despite subsections (1) to (3), a beneficiary under the Prescription Drug Payment Act, except a beneficiary under paragraphs 2.1(b) to (d) of New Brunswick Regulation 84-170 under that Act, is not a member of the Plan unless the person applies to the Director on a form provided by the Minister.

18( 5) A person applying for an exemption under subsection (3) shall provide proof of drug coverage to the Director on request.

18( 6) A person may apply to the Director for an exemption from the Plan if the person has drug coverage that falls under the authority of another jurisdiction but does not fall under subsection (3).

18( 7) If the Director approves an application for an exemption under subsection (3) or (6), the Director shall send a notice of approval to the person at his or her latest known address that includes the effective date of the exemption.

18( 8) If the Director denies an application for an exemption under subsection (3) or (6), the Director shall send a notice of refusal to the person at his or her latest known address that includes reasons for the denial, the effective date of the denial and the person’s right to appeal.

18( 9) A person who ceases to be exempt, or his or her parent or guardian, shall notify the Director in the manner prescribed by regulation within 30 days after ceasing to be exempt.

18( 10) A person referred to in subsection (9) is a member of the Plan on the date the person ceases to be exempt.

18( 11) If a member of the Plan has alternative drug coverage and the alternative coverage is not equal to the benefits under the Plan, benefits may be provided to the member, as the payor of last resort, for the difference.

Mandatory membership for dependants

19( 1) An entitled person shall obtain or maintain drug coverage for any dependant of the person.

19( 2) Subject to subsection 18(4), if a dependant is required to be exempted under subsection 18(3), the entitled person shall apply for the exemption on behalf of his or her dependant.

19( 3) If a dependant is also the dependant of another entitled person, the requirements referred to in subsections (1) and (2) apply to only one of them.

19( 4) Subject to a court order or a domestic contract, as defined in the Marital Property Act, if a dependant is not exempted from the Plan under subsection (2), a member of the family unit of the dependant shall obtain coverage for the dependant under the Plan.

19( 5) If a dependant referred to in subsection (4) has more than one family unit, a member of the family unit with the higher income shall obtain coverage for the dependant under the Plan.

Private group drug insurance

20( 1) An entitled person who is eligible for private group drug insurance provided by an insurer shall obtain or maintain the private group drug insurance unless otherwise prescribed by regulation.

20( 2) Subsection (1) does not apply to an entitled person who has drug coverage under paragraphs 18(3)(a) to (e).

Information provided by or relating to an entitled person

21( 1) The Director may require that an entitled person provide, on behalf of a dependant, proof that the dependant is a person with a disability.

21( 2) An entitled person shall provide the Director the information prescribed by regulation within the time prescribed by regulation.

21( 3) An entitled person shall provide the Director with a written statement that includes the information prescribed by regulation when the entitled person becomes a member of the Plan.

21( 4) If an entitled person fails to provide the required information under this Act and the regulations, the Director may deny coverage under the Plan or a benefit to the member of the Plan or to any dependant who is part of the member’s family unit.

PART 5

PROVIDERS

Participation and cancellation

22( 1) A provider may participate in the Plan by providing the Director with the information prescribed by regulation.

22( 2) A provider may cancel participation in the Plan if he or she complies with the following conditions at least 90 days before the effective date of the cancellation:

(a) he or she provides the Director in writing with the proposed date the provider will cease providing entitled services under the Plan;

(b) he or she publishes a notice of the proposed cancellation in a newspaper having general circulation in the area in which the provider practises or operates; and

(c) he or she posts a notice of the proposed cancellation for at least 90 days at the premises in which the provider practises or at the pharmacy in a clearly visible and prominent place where clients have access.

22( 3) Subsections (1) and (2) do not apply to a pharmacist practising at a pharmacy that operates in the Province.

Non-participating providers

23( 1) A provider who is not participating in the Plan and who provides entitled services to entitled persons shall

(a) post a notice at the premises in which the provider practises or at the pharmacy in a clearly visible and prominent place where clients have access advising clients that the provider is not participating in the Plan,

(b) ensure that each client is advised in person that the provider is not participating in the Plan before any entitled service is provided to the client, and

(c) ensure that each member of the Plan is advised in person that the provider may charge the member an amount for the drug, good or service that is higher than the amount charged by a participating provider.

23( 2) Subsection (1) does not apply to a pharmacist practising at a pharmacy that operates in the Province.

Sale to participating provider or pharmaceutical distributor

24 A person shall not sell an entitled service that is included on the list established by the Minister under subsection 30(1) to a participating provider or a pharmaceutical distributor for a price that is higher than the unit price of the drug or the price of the good or service specified on the list.

Sale to member of the Plan

25 A participating provider shall not charge a member of the Plan an amount for an entitled service that is greater than the amount determined by the Minister in accordance with a method of determining the amount prescribed by regulation.

No benefits to non-members

26 A participating provider shall not knowingly provide a benefit for a person who is not a member of the Plan.

Claims to the Director

27( 1) A participating provider who provides an entitled service to a member of the Plan shall submit a claim to the Director with the information prescribed by regulation within the time prescribed by regulation.

27( 2) The Minister shall determine the amount to be paid to a participating provider in respect of any entitled service provided as a benefit in accordance with a method of determining the amount prescribed by regulation.

27( 3) A participating provider shall not submit a claim for the cost of a benefit if the participating provider has not provided the benefit.

27( 4) A participating provider shall not submit a claim for an entitled service that is provided

(a) in a regional health authority as defined in the Regional Health Authorities Act unless an agreement between the Minister and the regional health authority provides otherwise, or

(b) in a private hospital facility in the Province as defined in the Medical Services Payment Act unless an agreement between the Minister and the private hospital facility provides otherwise.

27( 5) A non-participating provider shall not submit a claim to the Director.

Non-compliance

28( 1) If the Director believes, on reasonable grounds, that a participating provider has violated or failed to comply with a provision of this Act or the regulations, the Director may

(a) issue a warning letter to the provider,

(b) make an order suspending the provider’s participation in the Plan for the period specified in the order, and

28( 2) An order under paragraph (1)(b) or (c) shall be served on the participating provider by personal service or registered mail.

PART 6

BENEFITS

Formulary

29( 1) The Director shall prepare, maintain and publish a Plan Formulary that specifies all entitled services.

29( 2) The Plan Formulary shall specify

(a) the generic name, brand name and manufacturer’s name of an entitled service,

(b) an entitled service that is only an entitled service in the cases, on the conditions or based on the criteria determined by the Director, if applicable, and

29( 3) The Director may make changes to the Plan Formulary that he or she considers appropriate and, if changes are made, the Director shall specify in the Plan Formulary the effective date of the change for the Plan and for minimum requirements under section 40, if applicable.

29( 4) A member of the Plan, or a provider or medical practitioner on behalf of the member, may request, in the manner prescribed by regulation, that the Director approve a drug, good or service that is not covered under the Plan for a member of the Plan or a class of members of the Plan by providing the Director with the information prescribed by regulation.

29( 5) A manufacturer may request that the Director include a drug produced by it in the Plan Formulary and, when doing so, the manufacturer shall provide the Director with any information required by the Director accompanied by the fees, if any, prescribed by regulation.

List of prices

30( 1) The Minister shall establish, in the manner prescribed by regulation, a list of unit prices of drugs that are entitled services and prices of goods and services that are entitled services.

30( 2) A manufacturer shall provide the Minister with any information that the Minister requires for the purpose of determining the unit price of a drug or the price of a good or service.

Entitlement to benefits

31( 1) A member of the Plan is entitled to a benefit when an entitled service is provided

(a) by a provider in the Province, or

(b) by a pharmacy outside the Province, but in Canada.

31( 2) Despite paragraph (1)(b), a member of the Plan may be entitled to a benefit when an entitled service is provided outside Canada in the circumstances prescribed by regulation.

31( 3) The reimbursement amount to be paid to a member of the Plan when an entitled service is provided outside the Province shall not exceed the amount that would have been paid to the member if the entitled service had been provided in the Province.

Exceptions

32 Despite any other provision of this Act, a benefit shall not be provided for an entitled service received by a member of the Plan

(a) in a regional health authority as defined in the Regional Health Authorities Act unless an agreement between the Minister and the regional health authority provides otherwise,

(b) in a private hospital facility in the Province as defined in the Medical Services Payment Act unless an agreement between the Minister and the private hospital facility provides otherwise, or

Evidence of membership

33( 1) A member of the Plan requesting a benefit from a participating provider shall provide the participating provider with evidence of membership in the Plan as prescribed by regulation.

33( 2) A person shall not knowingly request a benefit from a participating provider

(a) that the person is not entitled to, or

(b) that the person on whose behalf the person is requesting the benefit is not entitled to.

Reimbursement for entitled services

34( 1) A member of the Plan requesting reimbursement for the cost or a portion of the cost of an entitled service shall submit a claim to the Director on a form provided by the Minister, accompanied by any other information required by the Director, within the time prescribed by regulation.

34( 2) The Director may approve or deny a claim under subsection (1) and, if the claim is denied, the Director shall advise the member of the Plan in writing with reasons.

Restrictions

35 The Director may impose restrictions on a member of the Plan relating to the number of providers who are able to provide benefits to the member or the quantity of benefits that may be provided to the member in the circumstances prescribed by regulation.

PART 7

FUNDING

Premiums

36( 1) A member of the Plan shall pay the premiums set by regulation to the Plan Administrator within the time and in the manner prescribed by regulation.

36( 2) The Minister may provide a subsidy for premiums and co-payments to a family unit that applies to the Minister within the time and in the manner prescribed by regulation.

36( 3) Each entitled person in a family unit except a dependant is jointly and severally liable to pay the premiums of the family unit.

36( 4) The Plan Administrator may reimburse any overpayment of premiums if a member of the Plan applies for a reimbursement within the time and in the manner prescribed by regulation.

Employers

37( 1) An employer may remit premiums to the Director on behalf of an employee in the circumstances prescribed by regulation by providing the Director the information prescribed by regulation.

37( 2) An employer who remits premiums to the Director under subsection (1) shall

(a) remit the total amount paid to the employer by his or her employee as premiums, and

(b) remit premiums within the time prescribed by regulation.

37( 3) Premiums remitted under subsection (1) shall be accompanied by a statement in the form provided by the Minister.

37( 4) Premiums paid by an employee to an employer are deemed to have been received by the Director on the date the employee pays the employer.

37( 5) If an employer violates or fails to comply with this section, the Director may prohibit the employer from remitting premiums on behalf of his or her employees.

Plan funding reviews

38( 1) On April 1, 2016, and each following April 1, the Minister shall undertake a review of the funding of the Plan to establish the premium rates necessary to finance the future benefits and administrative expenses payable under the Plan.

38( 2) If the Plan has a surplus or a deficit on April 1 of any year that is greater than 5% of the benefits paid under the Plan in the previous 12 months, premium rates shall be established that deplete the surplus or fund the deficit within five years.

38( 3) Before April 1, 2018, and at least every five years after that date, the Minister shall undertake a review of the subsidies under subsection 36(2), the minimum requirements under paragraph 40(f) and the co-payments prescribed by regulation.

PART 8

MINIMUM REQUIREMENTS

Health insurance

39 An insurer shall provide drug coverage if the insurer provides private group health insurance to residents of the Province, including vision, dental or medical insurance or a health spending account that falls within the definition of “private health services plan” under the Income Tax Act (Canada), but excluding disability, life, accidental death or dismemberment or critical illness insurance.

Private group drug insurance

40 An insurer who provides private group drug insurance to residents of the Province shall comply with the following minimum requirements:

(a) the entitled services listed as minimum requirements in the Plan Formulary shall be covered for all insured persons under the contract;

(b) coverage shall be offered for each person in the family unit;

(c) coverage shall be offered for a child over 19 years of age, but under 26 years of age, who is a full-time student at a secondary or post-secondary educational institution;

(d) a person shall not be refused coverage on the basis of the person’s age, sex or state of health or the age, sex or state of health of a member of the person’s family unit;

(e) an insured person shall not be required to pay a different premium than the other insured persons in the group based on the insured person’s age, sex or state of health or the age, sex or state of health of a member of the insured person’s family unit; and

(f) the minimum requirements prescribed by regulation.

Certificate of private group drug insurance

41 On or before April 1, 2015, or on or before the effective date of the coverage, an insurer who provides private group drug insurance to residents of the Province shall provide a certificate of insurance to each person insured under the contract that contains the information prescribed by regulation.

Information provided by the insurer

42 On request of the Director, an insurer shall provide the Director the information prescribed by regulation.

PART 9

ENFORCEMENT

Inspectors

43( 1) The Minister may designate persons as inspectors for the purposes of this Act and the regulations.

43( 2) The Minister shall issue to an inspector a certificate of appointment bearing the Minister’s signature or a facsimile of it.

43( 3) An inspector who exercises powers under this Act or the regulations shall produce his or her certificate of appointment on request.

Inspections

44( 1) At any reasonable time, an inspector may enter and inspect premises at which a participating provider practises or operates for the purpose of ensuring compliance with this Act and the regulations.

44( 2) During an inspection, an inspector may do any of the following:

(a) require to be produced for inspection, or for the purpose of obtaining copies or extracts, any record or document; and

(b) make those examinations and inquiries of any person that the inspector considers necessary to ensure compliance with the provisions of this Act and the regulations.

44( 3) Immediately on demand by an inspector, the person shall produce a record or document required by the inspector under subsection (2).

44( 4) Every person shall give an inspector all reasonable assistance to enable the inspector to carry out an inspection under this section, including providing the inspector with the information that the inspector reasonably requires.

Confidentiality of information

45( 1) A statement, declaration, record or document made or given by a person on request of an inspector in the course of an inspection is confidential and for the information and use of the Minister only and may not be inspected by any other person without the written authorization of the Minister.

45( 2) If this section is inconsistent with or in conflict with a provision of the Right to Information and Protection of Privacy Act, this section prevails.

Obstruction of inspector

46 No person shall obstruct or interfere with an inspector who is carrying out or attempting to carry out an inspection under section 44.

Powers of the Minister

47( 1) After an inspection has been conducted, the Minister may, in writing, order the participating provider to pay an amount owing to the Minister.

47( 2) A person who is subject to an order under subsection (1) may appeal the order to a judge of The Court of Queen’s Bench of New Brunswick.

Offences

48( 1) A person who fails to remit an amount owing under this Act commits an offence punishable under Part 2 of the Provincial Offences Procedure Act as a category E offence.

48( 2) A person who knowingly makes a statement, either orally or in writing, or submits a document or record under this Act that is incomplete or that contains false or misleading information commits an offence punishable under Part 2 of the Provincial Offences Procedure Act as a category F offence.

48( 3) A person who knowingly fails to provide any information, document or record or fails to maintain any document or record as required by this Act commits an offence punishable under Part 2 of the Provincial Offences Procedure Act as a category F offence.

48( 4) A person who violates or fails to comply with a provision of this Act that is listed in Column I of Schedule A commits an offence.

48( 5) For the purposes of Part 2 of the Provincial Offences Procedure Act, each offence listed in Column I of Schedule A is punishable as an offence of the category listed beside it in Column II of Schedule A.

48( 6) A person who violates or fails to comply with a provision of the regulations commits an offence that is punishable under Part 2 of the Provincial Offences Procedure Act as a category B offence.

48( 7) Despite subsection (6), a person who violates or fails to comply with a provision of the regulations in respect of which a category has been prescribed under paragraph 63(jj) commits an offence of the category prescribed by regulation.

48( 8) A member of the Plan who is convicted of an offence under this Act or the regulations forfeits any right to receive a benefit during the time prescribed by regulation.

Continuing offence

49 If an offence under this Act or the regulations continues for more than one day,

(a) the minimum fine that may be imposed is the minimum fine set by the Provincial Offences Procedure Act multiplied by the number of days during which the offence continues, and

(b) the maximum fine that may be imposed is the maximum fine set by the Provincial Offences Procedure Act multiplied by the number of days during which the offence continues.

Notice of non-compliance

50( 1) If the Minister believes, on reasonable grounds, that a person has violated or failed to comply with a provision of this Act that is listed in Schedule B or a provision of the regulations, the Minister may issue a notice of non-compliance.

50( 2) The Minister shall serve a notice of non-compliance on the person to whom it is directed in the manner prescribed by regulation.

50( 3) The notice of non-compliance shall include the information prescribed by regulation.

50( 4) A notice of non-compliance shall not be served more than one year after the Minister first had knowledge of the violation or failure to comply.

50( 5) Subject to section 51, a person who receives a notice of non-compliance shall comply with the provision within 15 days after being served with the notice.

Written submissions

51( 1) A person who receives a notice of non-compliance may make a written submission to the Minister within 15 days after being served with the notice.

51( 2) Within 30 days after receiving a written submission, the Minister shall

(a) issue a notice indicating that the Minister is satisfied of the following:

( i) an error or omission exists with regard to the issuance of the notice of non-compliance;

( ii) an extenuating circumstance beyond the control of the person prevented compliance with the provision of this Act that is listed in Schedule B or the provision of the regulations; or

( iii) due diligence was exercised by the person to attempt to prevent the violation or failure to comply with the provision of this Act that is listed in Schedule B or the provision of the regulations;

(b) issue a notice extending the time referred to in subsection 50(5), or

Administrative penalty and offence

52( 1) A person subject to an administrative penalty shall not be charged with an offence in respect of the same incident that gave rise to the administrative penalty.

52( 2) A person charged with an offence shall not be subject to an administrative penalty in respect of the same incident that gave rise to the charge.

Notice of administrative penalty

53( 1) The Minister shall impose an administrative penalty by issuing a notice of administrative penalty in the following circumstances:

(a) a person does not comply within the time referred to in subsection 50(5);

(b) a person does not submit a written submission within the time referred to in subsection 51(1); or

53( 2) The Minister shall serve a notice of administrative penalty on the person to whom it is directed in the manner prescribed by regulation.

53( 3) The notice of administrative penalty shall include the information prescribed by regulation.

53( 4) A notice of administrative penalty shall not be served more than one year after the Minister first had knowledge of the violation or failure to comply.

Appeal of administrative penalty

54 A person who receives a notice of administrative penalty may appeal the decision of the Minister to a judge of The Court of Queen’s Bench of New Brunswick.

Payment of administrative penalty

55( 1) If a person who receives a notice of administrative penalty does not appeal under section 54, the person shall pay the administrative penalty set out in the notice within 15 days after being served with the notice.

55( 2) The administrative penalty shall be payable to the Minister.

55( 3) For the purposes of this Act only, a person who pays an administrative penalty shall be deemed to have violated or failed to comply with the provision of this Act that is listed in Schedule B or the provision of the regulations in respect of which the payment was made.

Debt due to the Province

56( 1) An amount owing to the Minister under this Act or the regulations becomes a debt due to the Province.

56( 2) The Minister may issue a certificate stating the amount of the debt due and the name of the debtor.

56( 3) A certificate issued under subsection (2) may be filed in The Court of Queen’s Bench of New Brunswick and entered and recorded in the Court and when entered and recorded may be enforced as a judgment obtained in the Court by the Crown in right of the Province against the person named in the certificate for a debt of the amount specified in the certificate.

56( 4) All reasonable costs and charges resulting from the filing, entering and recording of a certificate under subsection (3) may be recovered as if the amount had been included in the certificate.

56( 5) The Minister may charge interest on an amount owing to the Minister under this Act or the regulations at an interest rate prescribed by regulation.

Immunity

57 No action or other proceeding may be brought against any of the following persons for anything done or not done, or for any neglect, in the performance or exercise, or the intended performance or exercise, in good faith of a power or duty under the authority of this Act or the regulations:

(a) the Minister;

(b) the Director;

(d) a member or former member of the Advisory Committee;

(e) a member or former member of the Appeal Committee; or

(f) a person acting under or who has acted under the authority of this Act or the regulations.

Subrogation

58( 1) A person may make a claim for the personal injuries suffered by him or her against a person who was negligent or who did a wrongful act.

58( 2) If a person referred to in subsection (1) makes a claim, he or she shall attempt to recover the amount of the benefits paid under the Plan that he or she received.

58( 3) If a person under subsection (2) recovers the amount, or a portion of the amount, of the benefits paid under the Plan, he or she shall pay the amount to the Minister as soon as practicable.

58( 4) If a person referred to in subsection (1) does not make a claim, the Crown in right of the Province may maintain an action in its own name or in the name of the injured person for recovery of the amount of the benefits paid under the Plan.

58( 5) The Crown in right of the Province may maintain an action in its own name for recovery of the amount of the benefits paid under the Plan against a person referred to in subsection (1) who suffered personal injuries in the following circumstances:

(a) the person does not claim for the amount of the benefits paid under the Plan under subsection (2),

(b) the person does not pay to the Minister the amount in accordance with subsection (3), or

58( 6) It shall not be a defence to an action under subsection (5) that a release has been given, a claim has been settled or a judgment has been obtained unless

(a) the claim included a claim for the cost of the benefits paid under the Plan, and

(b) the Minister has approved the release or settlement under subsection (10) or (11).

58( 7) If the Minister approves in writing a release or settlement under subsection (11), the Crown in right of the Province may continue the action or maintain an action in its own name for recovery of the cost of the benefits paid under the Plan.

58( 8) Subject to subsection (11), if a settlement of the claim or a judgment does not provide complete recovery to the injured person for his or her losses and injuries and the cost of the benefits paid by him or her and the cost to the Crown in right of the Province for the amount of the benefits paid under the Plan, the two parties shall share pro rata in proportion to their respective losses the amount recovered in accordance with the terms and conditions prescribed by regulation.

58( 9) No person, without an approval by the Minister under subsection (10) or (11), shall make a settlement of a claim unless, at the same time, he or she makes a settlement to recover the same pro rata proportion in respect of the amount of the benefits paid under the Plan.

58( 10) No release or settlement of a claim or judgment is binding on the Crown in right of the Province unless the Minister has approved the release or settlement in writing.

58( 11) Despite subsection (10), if a person referred to in subsection (1) has obtained an offer for a settlement in which the same pro rata proportion of the amount of the benefits paid under the Plan would be recovered but, in the opinion of the Minister, the offer would not provide sufficient recovery in respect of the benefits paid under the Plan, the Minister may approve in writing a release or settlement in which the person making the claim makes a settlement of a claim in respect of his or her damages without making a settlement in respect of the amount of the benefits paid under the Plan.

58( 12) If a person whose negligent or wrongful act resulted in personal injuries to another person is insured by an insurer and a claim made in respect of those personal injuries does not include a claim for the cost of the benefits received by the injured person and paid under the Plan, the insurer shall pay to the Minister the amount of the benefits paid under the Plan and payment shall discharge the liability of the insurer to pay that amount to the insured person in any subsequent claim.

58( 13) An insurer shall provide the Minister, on request, information relating to

(a) a claim made against an insured person by a person who received benefits, and

(b) the terms and conditions of any settlement entered into by an insured person and a person who received benefits.

58( 14) In an action under this section, a certificate signed by the Minister or purporting to be signed by the Minister shall be admissible in evidence

(a) as conclusive proof

( i) that the person named in the certificate has received benefits,

( ii) that the amount recorded in the certificate is the cost of the benefits received by the person named in the certificate, and

( iii) of the office, authority and signature of the person signing or purporting to sign the certificate, without proof of his or her appointment, authority or signature, and

(b) as prima facie proof that the benefits were received in respect of the personal injuries suffered.

58( 15) This section does not apply if the personal injuries occurred as a result of the use or operation of a motor vehicle registered in the Province.

Levy

59 Despite section 5, the Minister may impose a levy, in accordance with the Insurance Act, for the purpose of recovering the amount of benefits paid under the Plan as a result of personal injuries suffered by an entitled person arising out of the use or operation of a motor vehicle registered in the Province.

PART 10

APPEAL COMMITTEE

Appeal Committee

60( 1) There is established an Appeal Committee consisting of members appointed by the Minister.

60( 2) The Appeal Committee shall hear appeals with respect to

(a) eligibility for the Plan or exemption from the Plan,

(b) an application under subsection 18(6) or a request under 29(4) that has been denied by the Director,

( i) the number of providers who are able to provide benefits to the member, or

( ii) the quantity of benefits that may be provided to the member.

60( 3) A decision of the Appeal Committee is final.

PART 11

GENERAL PROVISIONS

Administration

61 The Minister is responsible for the administration of this Act and may designate one or more persons to act on the Minister’s behalf.

Members of a family unit

62 For the purposes of this Act and the regulations, a member of the Plan may act on behalf of any member of his or her family unit.

Regulations

63 The Lieutenant-Governor in Council may make regulations

(a) prescribing health care professionals for the purposes of the definition “provider” in section 1;

(b) prescribing personal information and personal health information for the purposes of subsection 6(4);

(d) prescribing entities with which the Minister may enter into an agreement and the purposes for which the Minister may enter into an agreement under subsection 8(2);

(e) providing for appointments to the Advisory Committee, including the size and composition of the committee and the term of office and qualifications of its members and establishing procedures and quorum of the committee;

(f) fixing the remuneration of members of the Advisory Committee and setting the rate for reimbursement of expenses incurred by the members while exercising their powers or performing their duties;

(g) prescribing financial matters and any other matter within the mandate of the Advisory Committee under 10(2);

(h) respecting conflicts of interest pertaining to members of the Advisory Committee, including the circumstances that constitute a conflict of interest, the disclosure of a conflict of interest and the manner in which a conflict of interest is to be dealt with;

(i) prescribing information, including information

( i) to be provided to the Director by an entitled person for the purposes of subsection 12(1), 13(2), 18(3), and 21(2),

( ii) to be included on the written statements under subsections 13(3) and 21(3);

( iii) to be included in a certificate of insurance under section 17 or 41,

( iv) to be provided to the Director by a provider for the purposes of subsection 22(1),

( v) to be provided to a member of the Plan by a participating provider when the participating provider provides a benefit,

( vi) to be provided to the Director by a participating provider for the purposes of subsection 27(1),

( vii) to be provided to a member of the Plan by a participating provider if the participating provider substitutes a drug specified in a prescription for another drug,

( viii) to be provided to the Director by a person making a request under subsection 29(4),

( ix) to be provided by a member of the Plan applying for a subsidy under subsection 36(2),

( x) to be provided to the Director by an employer under subsection 37(1) or by an employer who is remitting premiums on behalf of his or her employees,

( xi) to be provided to the Director by an insurer under section 42,

( xii) to be included in a notice of non-compliance under subsection 50(3), and

( xiii) to be included in a notice of administrative penalty under subsection 53(3);

(j) prescribing the manner of providing notice under this Act, including

( i) a notice that membership has been denied under subsection 12(8), and

( ii) a notice by a person who ceases to be exempt under subsection 18(9);

(k) prescribing the time within which

( i) an entitled person shall provide the information to the Director under subsection 13(2) or 21(2),

( ii) a member of the Plan shall pay the premium under subsection 15(1) or 36(1),

( iii) a member of the Plan shall make an application for a reimbursement under subsection 15(2) or 36(4),

( iv) a participating provider shall submit a claim under subsection 27(1),

( v) a member of the Plan shall submit a claim under subsection 34(1),

( vi) a member of the Plan shall apply for a subsidy under subsection 36(2),

( vii) a member of the Plan shall notify the Minister of any change to the information provided by the member relating to a subsidy application,

( viii) an employer may remit premiums under paragraph 37(2)(b),

( ix) a member forfeits any right to receive any amount payable for the purposes of subsection 48(8),

( x) the Minister shall serve a notice of non-compliance under subsection 50(2), and

( xi) The Minister shall serve a notice of administrative penalty under subsection 53(2);

(l) respecting premiums under subsection 15(1) or 36(1), including prescribing different premiums based on the class of the member of the Plan;

(m) establishing co-payments payable by a member of the Plan, including establishing different co-payments based on the class of the member of the Plan or the class of entitled services;

(n) establishing classes of persons who are exempt from paying all or a portion of their premiums and co-payments;

(o) prescribing the manner in which

( i) a member of the Plan shall pay premiums under subsection 15(1) or 36(1),

( ii) a member of the Plan shall make an application under subsection 15(2) or 36(4),

( iii) a person may apply for an exemption under subsection 18(5),

( iv) a participating provider may substitute a drug specified in a prescription for another drug,

( v) a person shall make a request under subsection 29(4),

( vi) the Minister shall establish a list under subsection 30(1), and

( vii) a member of the Plan may apply for a subsidy under subsection 36(2);

(p) establishing drug coverage for the purposes of paragraph 18(3)(e);

(q) prescribing the circumstances in which

( i) an entitled person is not required to obtain or maintain private group drug insurance under subsection 20(1),

( ii) a participating provider may substitute a drug specified in a prescription for another drug,

( iii) a member of the Plan may be entitled to a benefit under subsection 31(2),

( iv) a benefit shall not be provided for the purposes of paragraph 32(c),

( v) the Director may deny a claim for the purposes of subsection 34(2),

( vi) restrictions may be imposed by the Director under section 35,

( vii) a subsidy may be recalculated for the purposes of a benefit period,

( viii) the Plan Administrator may reimburse a member of the Plan for any overpayment made by the member to a participating provider or for any underpayment made by the Director to the member under subsection 36(4),

( ix) an employer may remit premiums under subsection 37(1), and

( x) the Plan Administrator may reimburse any overpayment of co-payments;

(r) prescribing additional amounts to be paid by a member of the Plan if the member refuses a substitution of a drug specified in a prescription for another drug by a participating provider;

(s) prescribing additional information that shall be provided to each client of a provider who is not participating in the Plan;

(t) prescribing the amount to be charged to a member of the Plan by a participating provider for the purposes of section 25, including prescribing different amounts based on the class of the member;

(u) prescribing the method of determining the amount to be paid by the Minister to a participating provider under subsection 27(2), including the circumstances in which a reassessment may be conducted and an adjustment to the amount may be made;

(v) prohibiting a participating provider from imposing specified conditions on a member of the Plan in relation to providing a benefit;

(w) imposing restrictions or conditions on the payment to participating providers in relation to

( i) the frequency of dispensing of entitled services, and

( ii) the quantity of a class of entitled services that may be dispensed at one time or intervals within which refills may be dispensed;

(x) imposing rules, terms, restrictions or conditions respecting price reductions provided to participating providers in relation to entitled services or classes of entitled services;

(y) prescribing fees to be paid by a manufacturer for the purposes of 29(5);

(z) prescribing conditions for varying the price of an entitled service or a class of entitled services for the purposes of subsection 30(1);

(aa) prescribing evidence of membership in the Plan for the purposes of subsection 33(1);

(bb) establishing different classes of members of the Plan;

(cc) establishing different classes of entitled services;

(dd) establishing different programs under the Plan;

(ee) prescribing benefit periods that may apply to the enrolment of members of the Plan or classes of members of the Plan;

(ff) establishing eligibility criteria for a subsidy for the purposes of subsection 36(2);

(gg) respecting subsidy rates, including setting different rates based on the class of the member of the Plan;

(hh) prescribing minimum requirements for the purposes of section 40(f);

(ii) prescribing the circumstances in which an insurer shall notify the Director of changes to or the cancellation of an insurance contract and the manner and time of providing the notice;

(jj) prescribing, in respect of offences under the regulations, categories of offences for the purposes of Part 2 of the Provincial Offences Procedure Act;

(kk) prescribing provisions of this Act or the regulations for the purposes of section 50 and prescribing the amount of an administrative penalty or providing for the determination of the amount of an administrative penalty by prescribing the method of calculating the amount and the criteria to be considered in determining the amount;

(ll) prescribing the manner of service, including the manner of service of

( i) a notice of non-compliance under subsection 50(2), and

( ii) a notice of administrative penalty under subsection 53(2);

(mm) prescribing the maximum amount of an administrative penalty;

(nn) setting an interest rate for the purposes of subsection 56(5);

(oo) prescribing the terms and conditions on which the parties shall share pro rata under subsection 58(7);

(pp) respecting appeals under section 60, including

( i) the appointment and qualifications of the members of the Appeal Committee,

( ii) the appointment of the chair of the Appeal Committee,

( iii) the remuneration and compensation of the members of the Appeal Committee,

( iv) the procedures to be followed by, the conduct of hearings by and the rendering of decisions by the Appeal Committee,

( v) conflicts of interest pertaining to members of the Appeal Committee, including the circumstances that constitute a conflict of interest, the disclosure of a conflict of interest and the manner in which a conflict of interest is to be dealt with,

( vi) the grounds for appealing a decision and the grounds on which an appeal may be refused,

( vii) the form, manner and procedures with respect to an appeal, and

( viii) the fees with respect to an appeal;

(qq) prescribing forms and authorizing the Minister to provide forms for the purposes of this Act and the regulations;

(rr) defining “co-payment” and any other word or expression used in this Act but not defined in this Act, for the purposes of this Act, the regulations or both;

(ss) respecting any other matter or thing necessary or advisable to carry out the intent of this Act.

PART 12

TRANSITIONAL PROVISIONS, CONSEQUENTIAL AMENDMENTS AND COMMENCEMENT

Private drug insurance contracts

64( 1) From the date this Act receives first reading in the Legislative Assembly to March 31, 2015, both dates inclusive, an insurer shall not amend a private drug insurance contract or cancel a private drug insurance contract if the purpose of the amendment or the cancellation is to decrease coverage for drugs that are entitled services, reduce the amount that is paid to an insured person under the contract or increase the amount that is paid by an insured person under the contract unless the insurer applies to the Director for an exemption and, in the opinion of the Director, the insurer is not requesting the amendment or cancellation for the dominant purpose of transferring the insured person to the Plan.

64( 2) For the purposes of subsection (1), the insurer is not requesting the amendment or cancellation for the dominant purpose of transferring the insured person to the Plan if

(a) the insured person knowingly misrepresents or fails to disclose any fact required to be disclosed,

(b) the insured person contravenes a term of the contract or commits a fraud, or

Personal Health Information Privacy and Access Act

65 Subsection 48(1) of the Personal Health Information Privacy and Access Act, chapter P-7.05 of the Acts of New Brunswick, 2009, is amended

(a) in paragraph (b) of the English version by striking out “and” at the end of the paragraph;

(b) in paragraph (c) by striking out the period at the end of the paragraph and substituting a semicolon followed by “and”;

(d) to verify the individual’s eligibility to participate in the drug insurance plan under the Prescription and Catastrophic Drug Insurance Act.

Commencement

66( 1) Subject to subsections (2) and (3), this Act comes into force on April 1, 2014.

66( 2) Parts 4, 7 and 8 come into force on April 1, 2015.

66( 3) Despite subsection (2), section 37 comes into force on a day to be fixed by proclamation.

SCHEDULE A

Column I		Column II
Section		Category of Offence
	17...............		C
	24...............		C
	25...............		F
	26...............		F
	27(3) ...............		F
	33(2) ...............		F
	37(2)(a) ...............		H
	37(2)(b) ...............		E
	37(3) ...............		C
	41...............		C
	46...............		E

SCHEDULE B

Section
	15(1)
	36(1)
	37(2)(b)
	37(3)