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PharmaCare Transition

 

The FNHA joined BC PharmaCare on October 1, 2017. FNHA clients are now part of the provincial drug benefits insurance program.

Most First Nations in BC are automatically enrolled with PharmaCare Plan W.  No additional forms or registration is required. You can be sure that you are automatically enrolled if you received a letter from FNHA advising you of the PharmaCare Transition, or if FNHA already pays for your MSP premiums.

If you have any questions, our Health Benefits Support line is available. Call us at 1.855.550.5454.​

This transition to PharmaCare is the first step in an overall plan to bring decision-making about health benefits closer to home and into the hands of First Nations. The FNHA PharmaCare plan is a fully paid plan and BC PharmaCare is the first payer for FNHA clients.  

Key benefits for FNHA clients include: ​

• ​Increased ease of access to benefits and services.

• A streamlined approvals process that reduces the number of steps needed for prescription approvals.

• Integrating benefits with the Province of BC will reduce confusion for clients who have often had to navigate both federal and provincial services.

• A closer working partnership with PharmaCare, pharmacists, and physicians/nurse practitioners, all of whom have an interest in better outcomes for FNHA clients.

• FNHA is now better positioned to transform benefits to reflect the cultures and perspectives of BC First Nations and incorporate First Nations' models of wellness.

• Over time, stronger relationships will develop with providers to better coordinate benefits and fully integrate the program within a client's circle of care.

Clients are encouraged to bring both their BC Services Card/CareCard and Status Card to the pharmacy to access your drug benefits. Most FNHA clients have been automatically enrolled in PharmaCare Plan W. If you don't have your MSP premiums paid by FNHA, contact our FNHA benefit support representatives at 1.855.550.5454. 

Additional information:

• You can find the full Plan W formulary here. The PharmaCare formulary search tool is a resource to help you check if your drugs are covered by Plan W. To learn how to use the PharmaCare formulary search tool, watch the short video below or read this instructio​nal guide.

• FNHA clients have coverage for over-the-counter items through PharmaCare. Please view this list for over-the-counter items available with Plan W and this list for non-drug over-the-counter products.

• A small number of it ems continue to be covered by NIHB. Please see this list to see which items will be covered by NIHB.

• A small percentage of clients may need to change their medications. View this list of drugs that are impacted. If you have any questions about the medication you're receiving, we recommend speaking with your doctor or other health care provider.

• PharmaCare is a provincial program and cannot pay directly for prescriptions filled outside of BC. If you are travelling outside of BC, make sure you plan ahead to ensure you have enough medication for your trip. If you plan to travel outside of BC, you can usually "top up" your prescription to the maximum days' supply PharmaCare covers. You can use this early top-up option only once every 6 months. If you do need to fill your prescription at an out-of-province pharmacy, you can apply for reimbursement. Please see our page for more details on client reimbursements.​

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If you have a health condition supported by a provincial agency for: Cancer diagnosis (BC Cancer Agency); Organ transplant (BC Transplant); Chronic kidney disease (BC Renal Agency); or HIV/AIDS (BC Centre for Excellence for HIV/AIDS); please speak to your doctor or specialist to ensure you are enrolled or registered in the appropriate agency. While you enroll, there is a six-month transition period is in place until April 1, 2018 to ensure you continue to receive the medications you need.

Please read important information about provincial agency enrollment he​re.

Review our Frequently Asked Questions and contact us if you have any additional questions. Call our toll free Health Benefits Support line at 1.855.550.5454 or email us at  HealthBenefits@fnha.ca 


Watch the webinars below​​​!
​​​
 

Quick Links

Drug Benefits for FNHA Clients is a list of resources for pharmacy providers.​


​FNHA Website​​PharmaCare Transition Information:​

http://www.fnha.ca/benefits/pharmacare-transition

​Browse ​FNHA's website for important information and ​documents.
​BCPhA eTraining Portalhttps://www.bcpharmacy.ca/education/etraining​Login with BCPhA email and password to access public and member-only courses.
​Transitional Coverage Request Formhttp://www.fnha.ca/Documents/FNHA-Transitional-Coverage-Request-Form​.pdf​This manual claim process allows payment of the claim and extra time to resolve a coverage issue.   Please contact FNHA if you have a case where you are uncertain of its appropriate use.
​FNHA-PharmaCare Coverage Continuity Guide​Pharmacist's Guide for RDP, LCD and Non Benefits:

https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/pharm_guide_co​vg_cont.pdf

​PharmaCare Coverage – Pharmacist's guide for RDP, LCA and Non-Benefits for FNHA clients.
​First Nations Health Benefits (Plan W) Over the Counter Benefits​List of OTC items listed as benefits specific to Plan W:

https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/planw-otc-meds.pdf

​This list of OTC items is specific for Plan W and is in addition to OTC items that are already PharmaCare benefits.

 

Note: some of these items may not yet appear on the PharmaCare Formulary Search tool.

​Pharmacist-Initiated OTC Treatments​List of Conditions Covered:

https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/pharm_initiated_otc.pdf

 

Processing Claims Information:

https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/newsletters/news17-010.pdf

​Treatments initiated by the pharmacist for select minor ailments can be reimbursed by Plan W. Claims should be entered into PharmaNet the same way as other prescriptions.
​Plan W Non-drug OTC Benefitshttps://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/pharmacies/product-identification-numbers/plan-w-non-drug-otc-benefits​This document contains PINs for general supplies; diabetic supplies; inhaler spacers; and IUDs.
​NIHB Residual List for FNHA Clients​Residual List:

http://www.fnha.ca/Documents/NIHB-Formulary-List-for-FNHA-Clients-Enrolled-in-Plan-W-Providers.PDF

 

Algorithm for Coverage:

https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/pharm_guide_covg_cont.pdf

​To ensure continuity of coverage, NIHB covers select prescription and non-prescription items not listed in Pharmacare Plan W. 
​NIHB Parallel Plan for FNHA clients not yet enrolled in Plan Whttp://www.fnha.ca/Documents/NIHB-Formulary-List-for-FNHA-Clients-Not-Enrolled-in-Plan-W.PDF​NIHB's Parallel Plan W for FNHA clients provides coverage for FNHA clients not yet enrolled in Plan W. 

 

Clients not yet enrolled in Plan W should be encouraged to call FNHA.

​Non-Insured Health Benefits Program Information​NIHB's Guide for Pharmacy Benefits:

https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/reports-publications/non-insured-health-benefits/guide-pharmacy-benefits-non-insured-benefits.html

 

NIHB Pharmacist Initiated Therapy:

https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/reports-publications/non-insured-health-benefits/guide-pharmacy-benefits-non-insured-benefits.html#chp3_13

 

ESC-NIHB Claims Submission Kit

http://provider.express-scripts.ca/pharmacy/claims-submission-kit

​These links provide information on the Indigenous Services Canada's rules and policies for claim submitted to and paid by NIHB.​



Plan​ W in PharmaCare Newsletters:​
October 4, 2018
  • • Submitting OTC Claims for Plan W Beneficiaries in Plan B Facilities
  • • Plan W covers ostomy supplies for FNHA clients
August 21, 2018
  • • Full Payment Policy & Plan W
  • • Basaglar covered as preferred insulin glargine brand
March 1, 2018
  • • Expiring Transitional SA's
  • • Exceptional & Limited Coverage Drugs
  • • Non-Drug OTC Benefits
  • • NIHB Residual Items
January 26, 2018
  • • Plan W Full Payment Policy
  • • Transitional SA Expiration Dates
November 14, 2017​
  • • Plan W compounds
  • • OTC reimbursements
  • • Claims issues for unregistered clients
October 17, 2017
  • • Plan W Formulary
  • • OTC Drug/Non-Drug Benefits
  • • Special Authorities
  • • Out-of-Province Claims
September 26, 2017
  • • PharmaCare Transition
  • • OTC Drug Benefits
  • • Devices, MS&E, BGTS
  • • Out-of-Province Claims
  • • Provincial Treatment Agencies
  • • Frequency of Dispensing
September 12, 2017
  • • MS&E Coverage
  • • Continuity of Coverage
August 8, 2017
  • •​ Transition to PharmaCare (Eligibility, Coverage, Payment Policy)​​

 Do you have questions?

​Contact us at 

HealthBenefits@fnha.ca 

or call 

1.855.550.5454​ (Toll Free)

 How was your experience?

​We want to hear from you about your experience with FNHA Health Benefits. Please take 5-10 minutes to fill out our survey here:

​Feedb​ack ​

​This client satisfaction survey will help us understand BC First Nations experiences accessing FNHA Health Benefits. We will use this information to improve the quality of our services.​​

Downlo​ad a print version of the FNHA Health Benefits Client Satisfaction Survey​

FNHA-Health-Benefits-Client-Satisfaction-Survey.jpg

Click here

​Client Satisfaction Survey FAQs

​Click here
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