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Health Care Providers Caring for Clients

​Important changes in health benefits on the way for FNHA clients

On October 1, 2017, all First Nations Health Authority clients will become beneficiaries of the BC PharmaCare program. Medications and therapies prescribed by healthcare providers will be filled based on the BC PharmaCare formulary as patients transfer from Health Canada's Non-Insured Health Benefits (NIHB) drug coverage program.  Please note the following:​

ELIGIBILITY (as of October 1, 2017)

• All FNHA Clients who are eligible for MSP are also eligible to enroll for the new FNHA PharmaCare program.

• Clients are eligible for all PharmaCare plans for which other BC residents are eligible.

FORMULARY CHANGE

• Although mos​t patients will continue to be eligible for the medications they need, a small percentage will have to adjust drug therapies as they switch to the PharmaCare formulary.

• Consider prescribing therapies based on the PharmaCare formulary for FNHA Clients

• Because the NIHB and PharmaCar​e formularies have minor differences, prescribers may need to work with a small number of FNHA clients in determining an appropriate change in therapies.

• View the list of drugs impacted by the transition to PharmaCare by brand name​.

• All FNHA clients currently taking a drug that is not normally fully-covered under the Reference Drug Program will be given indefinite, full PharmaCare coverage of their current medication.

TRAVELLING / OUT-OF-PROVINCE CLAIMS

• FNHA clients will not ha​ve PharmaCare coverage for prescriptions filled outside of BC.

• Please work with your FNHA clients to ensure that they fill their prescriptions in BC prior to travelling out of province.

•​ Some pharmacies near the BC border may be eligible to enroll with PharmaCare.


SPECIAL AUTHORITIES

•​ FNHA client​s who currently have Special Authorization for a drug through NIHB will be given transitional Special Authority coverage under PharmaCare. Going forward, any FNHA clients requiring a new Special Authority will require you to follow PharmaCare processes in obtaining one, including for "No Substitution" prescriptions. 

ADDITIONAL PHARMACARE BENEFITS

• Reference Drug Program (RDP) – All FNHA clients currently taking a drug that is not normally fully-covered under the RDP will be given indefinite, full PharmaCare coverage of their current medication. Starting October 1, 2017, new prescriptions for non-reference drugs will only be reimbursed by PharmaCare up to the reference comparator price, unless the client obtains a Special Authority. Please provide FNHA clients with information about the benefits of reference drugs and consider adapting their prescription as appropriate.

• Select over-the-counter (OTC) drugs and medical supplies and equipment (MS&E) – Most of these items are currently provided through NIHB, and will continue to be until further notice. Details will be provided when available.

• Restricted Claimant Program (RCP) – When necessary, FNHA clients may be placed in the RCP just like any other British Columbian. This will require prescribers to have a specific role in determining the appropriateness of a client's drug therapies and initiate contact with PharmaCare.

• Palliative care – Enroll FNHA clients, when appropriate, using the BC Palliative Care Benefits Registration form.

•​ Appeals - While appeals do not exist within the PharmaCare program, FNHA is developing an appeals process for clients. FNHA Clients may require physician support when appealing a denied PharmaCare claim. 

MORE INFORMATION

• Pharmacists can find further information in their Frequently Asked Questions.

• Prescribers (Physicians and Nurse Practitioners) can find further information in their Frequently Asked Questions​.

•​ Call 1.855.550.5454 or contact FNHA via email at 

HealthBenefi​ts@f​nha.ca for further information.


​Updated July 14, 2017

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