FNHA has been purchasing services from Health Canada to process client claims for dental, drugs and medical supplies since transfer in 2013. FNHA has entered into an Agreement with the Ministry of Health to plan the transition to BC PharmaCare and to develop a first-of-its-kind provincial First Nations drug benefit plan.
We want to utilize provincial systems where possible so that BC First Nations can access benefits in the same way as other British Columbians. By joining PharmaCare, we are leveraging provincial systems to streamline access to care for First Nations in BC.
Just like today, all drug claims are submitted to PharmaNet first. As of October 1st claims for eligible items will be adjudicated according to PharmaCare policies and following PharmaCare rules. There will be a select few items, such as over-the-counter medications, that will continue to be rejected by PharmaCare and you should send these to NIHB for adjudication, the same as you do today.
FNHA and PharmaCare are working with pharmacy software vendors to make sure all local pharmacy software is updated by October 1, 2017, and that claims will automatically adjudicate with PharmaCare as the first payer for eligible clients. The change should be transparent to users of the system. These updates will allow FNHA client claims to be processed through PharmaNet and adjudicated as first payer against PharmaCare without a "host processing error." The local pharmacy software will then be able to submit claims that have been rejected and/or not fully paid by PharmaCare to an extended healthcare plan (if client has one) and then to Health Canada's NIHB plan.
Should a system adjudication issue occur, please contact your software vendor.
It is important to note that the FNHA and BC PharmaCare are working together to ensure the smoothest possible transition to the new PharmaCare plan. For instance:
• The vast majority of FNHA clients will be enrolled in the new PharmaCare plan automatically.• FNHA clients who currently have Special Authorization for a drug through the NIHB will be given transitional Special Authority coverage under PharmaCare.• All FNHA clients currently taking a drug that is partially covered under the Reference Drug Program will be given indefinite, full PharmaCare coverage of their current medication.
• The vast majority of FNHA clients will be enrolled in the new PharmaCare plan automatically.
• FNHA clients who currently have Special Authorization for a drug through the NIHB will be given transitional Special Authority coverage under PharmaCare.
• All FNHA clients currently taking a drug that is partially covered under the Reference Drug Program will be given indefinite, full PharmaCare coverage of their current medication.
These are just a few examples of the strategies being put in place to reduce disruptions to patient coverage and to reduce administration for health care providers.
BC PharmaCare is a provincial program and it cannot cover prescriptions purchased outside the province. This is a significant change for some FNHA clients. We ask that all health care providers remind FNHA clients to plan ahead before they travel by obtaining the maximum days' supply of their medication before they leave the province.
There may be a few minor process exceptions as we fully transition from NIHB; information will be available about these in future communications.
Yes, there will still be a small number of NIHB clients in BC, such as such as First Nations not eligible for Plan W or those insured under another benefit plan provided by a First Nations Organization pursuant to self-government agreements (e.g. Nisga'a). Not all First Nations individuals in BC will be eligible for the new FNHA PharmaCare plan.
Your Point of Sale System should adjudicate FNHA clients appropriately based on their Personal Health Number. First Nations in BC who are eligible for FNHA Health Benefits should also be eligible for the new FNHA PharmaCare plan. Questions related to enrollment with FNHA can be directed to FNHA Health Benefits at 1-855-550-5454.
No, not all First Nations individuals in BC will be eligible for the new FNHA PharmaCare plan, such as those insured under another benefit plan provided by a First Nations Organization pursuant to self-government agreements (e.g. Nisga'a).
First Nations individuals residing out of province who are visiting BC will be covered by NIHB and not PharmaCare.
Please direct any questions related to FNHA Health Benefit enrollment can be directed to our FNHA client support representative at 1-855-550-5454.
No, the NIHB Provider agreement will remain in place to handle NIHB claims.
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