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New streamlined process improves access to palliative care benefits

​​​​​​​​For many, the transition from this life to what is beyond is a time to be home, surrounded by loved ones.

When a loved one is receiving palliative care, time is of the essence and red-tape should not be a barrier to getting care and medications needed. Yet, First Nations clients accessing palliative care benefits who wanted to die at home or in hospice faced delays and inequities in coverage in the system.

Where we needed a fast-flowing river, we had one filled with obstacles and debris. The FNHA Health Benefits team came together with BC's provincial drug plan, PharmaCare, and Health Canada's Non-Insured Health Benefits representatives to find a solution. Our new process, that came into effect on January 1st of this year, provide a more responsive, culturally-safe and supportive health system for those in palliative care.

Delays in coverage prevented palliative patients from returning home

Last August, FNHA and Interior Health nurses and palliative care providers from our Interior Region raised concerns about a client's experience. The issue was that while in hospital, palliative First Nations clients had their medications covered. However, if they wanted to go home or into a hospice, getting coverage for medications was a cumbersome, bureaucratic process.

At the heart of the issue was that under the service agreement with Health Canada, BC First Nations were navigating different health coverage systems – resulting in a delay in getting benefits.

In the old system, some medications, medical equipment, and in-home support services were covered by FNHA Health Benefits. Other medications were only covered by PharmaCare's Palliative Care Drug Plan. Our clients were unable to access PharmaCare Benefits without first applying for coverage with FNHA and receiving a rejection letter – a process that could take 4-10 days.

Many steps and lengthy delays to get medications covered resulted in clients being stuck in hospital, unable to return home or move into hospice care.​

Partnering to finding a solution

Addressing inequities in services between First Nations and other BC residents is one of the reasons our Nations came together to create the FNHA. Often, we tackle these challenges through ​meaningful collaboration and​​ partnerships​ to bring our services into alignment with what is offered to other BC residents.​

"The collaborative process of bringing this issue to our Partnership Accord Leadership Table and escalating to the Tripartite Committee on First Nations Health is a great example of how we can work together through our governance structures to bring systems issues to resolution," explains Mary McCullough, FNHA Interior Regional Manager.

When the Interior Region team brought this issue to the Tripartite Committee on First Nations Health, the FNHA, Health Canada, and BC Ministry of Health agreed that the status quo could not continue. Right away, FNHA's Health Benefits team joined our partners at BC PharmaCare, and Health Canada to identify the blockages and reach a solution.

"The dilemma was that First Nations people who required palliative care, usually pain medications,

were really delayed getting the drug therapy that they needed," says Mitch Moneo, Executive Director of PharmaCare's Information, Policy & Evaluation branch. "So we sat down with our colleagues at FNHA Health Benefits and together we tried to solve this problem that's been in existence for many years."

The aim was to create a streamlined and coordinated process to minimize coverage delays when a client is transitioning from hospital to community. Now, PharmaCare no longer requires a written confirmation from FNHA that a drug is not covered, before their coverage kicks in. Work is now underway to address issues specific to medical supplies and equipment.

"Our palliative clients should be able to focus on the important things like being with family," says John Mah, VP Health Benefits. "The complexities of coverage and who pays for what should be invisible in the background, not a burden on the client. That's why it was so important for us to fix this."

Click he​re to see BC PharmaCare's newsletter announcing this change.

Questions about palliative care coverage, talk to your local healthcare professional or contact Health Benefits Support Representative:

Toll Free: 1.855.550.5454

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