Important changes in health benefits on the way for FNHA clients
As of October 1, 2017, all First Nations Health Authority clients are BC PharmaCare beneficiaries. As the drug benefits are transferred from Health Canada's Non-Insured Health Benefits (NIHB) program to BC PharmaCare, please note the following:
ELIGIBILITY (as of October 1, 2017)
• All FNHA Clients who are eligible for the BC Medical Services Plan (MSP) are eligible for FNHA PharmaCare Plan W. benefits.
• Most FNHA clients have ready access to the FNHA PharmaCare Plan.
• FNHA clients who do not yet have access to Plan W benefits are encouraged to contact FNHA to have their coverage activated.
For additional eligibility information, click here.
DRUG BENEFIT LISTS
• Search the PharmaCare Plan W formulary here or download the entire formulary. Additionally, please view this list to find over-the-counter products available with Plan W and this list for non-drug over-the-counter products.
• To ensure continuity of therapies, NIHB will continue to provide coverage for a select few items not found on the PharmaCare Plan W formulary. Please see this list for the NIHB formulary for FNHA clients on Plan W.
• Although most 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. FNHA clients taking drugs on this list are advised to speak with their health care professional to ensure they get the medications they need.
• A small number of FNHA clients may not have access to the Pharmacare Plan W at this time. These clients will continue to have their prescriptions covered by NIHB's parallel Plan W formulary. For specific information regarding manufacturer information, please reference the NIHB Drug Benefit List.
• Special Authorities (SAs) will automatically be in place to continue coverage of existing medications on October 1, 2017
• The expiry of transitional SAs is specific to each drug
• Many SAs are indefinite
• For drugs that require renewal, prescribers will need to apply for SA within 4 – 6 months
• "High risk" drugs or drugs intended for short term treatments will be granted a 35 day expiry (e.g. Fragmin)
• Contact FNHA if a transitional SA was missed, or an SA for a hepatitis C drug expiry date does not align with the prescribed treatment duration
• Patients newly starting medications that require SA for coverage require their prescriber to apply for an SA through Pharmacare
Low Cost Alternative
• Low Cost Alternative program policies apply to Plan W claims
• Pharmacists should consider dispensing a fully covered drug
• Exceptional SAs will be grandparented to allow continued coverage of drugs otherwise considered non-benefit
• The expiry of grandparented SAs is specific to each drug
• Contact FNHA if a patient was missed for grandparented coverage (e.g. no substitution products)
Reference Drug Program (RDP)
• Reference Drug Program policies apply to Plan W claims
• If a patient is newly started on a non-reference drug that is part of the RDP, pharmacists should consider adapting the prescription to a medication that will be covered
• FNHA clients currently taking a drug that is partially covered under the RDP will be grandparented full coverage of their current medication
Transitional Coverage Request Form
• For transitional coverage issues, pharmacists can bill the prescription to FNHA through an interim exceptional process by completing and faxing a Transitional Coverage Request form to FNHA
• This transitional coverage request allows pharmacists and prescribers the time to reassess/change a patient's medication for Plan W coverage
• This transitional coverage request form is a one-time fill per drug per patient, if appropriate
• Pharmacists will be reimbursed $10 in addition to the usual drug cost plus dispensing
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.
• Pharmacists can find further information in their Frequently Asked Questions, along with this reference guide to assist with drug coverage decisions.
• 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 HealthBenefits@fnha.ca for further information.
Updated October 6, 2017
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