FNHA has been purchasing services from Health Canada to process client claims for dental, drugs and medical supplies since transfer in 2013. FNHA entered into an agreement with the Ministry of Health and transitioned our drug benefits to BC PharmaCare Plan W on October 1, 2017. This is a first-of-its-kind provincial First Nations drug benefit plan.
Plan W offers 100% coverage of the eligible costs of drugs, dispensing fees, and pharmacy services, including many over-the-counter medications. FNHA clients are now covered by PharmaCare and subject to the same PharmaCare policies and processes as other BC residents. Plan W is the first payer and primary pharmacy drug plan for eligible FNHA clients.
A small number of items continue to be covered by Health Canada's Non-Insured Health Benefits (NIHB) program to ensure continuity of therapies. Additionally, medical supplies and equipment (MS&E) continue to be covered by NIHB until they can also be transitioned. A Third Party Provider will be introduced in approximately late 2018 to replace NIHB and provide coverage for MS&E items and those few drugs that are not covered by PharmaCare.
It is important to note that the FNHA and BC PharmaCare have worked together to ensure the smoothest possible transition to the new PharmaCare plan. For instance:
• The vast majority of FNHA clients have been enrolled in the new PharmaCare plan automatically. • FNHA clients who had Special Authorization for a drug through the NIHB have been given transitional Special Authority coverage under PharmaCare.• All FNHA clients that are taking drugs partially covered under the Reference Drug Program have been given indefinite, full PharmaCare coverage of their current medication.
• The vast majority of FNHA clients have been enrolled in the new PharmaCare plan automatically.
• FNHA clients who had Special Authorization for a drug through the NIHB have been given transitional Special Authority coverage under PharmaCare.
• All FNHA clients that are taking drugs partially covered under the Reference Drug Program have been given indefinite, full PharmaCare coverage of their current medication.
These are just a few examples of the strategies put in place to reduce disruptions to patient coverage and to reduce administration for health care providers.
Please help your patients obtain coverage for drugs and access to provincial programs for FNHA clients as you would for any other BC resident. Consider prescribing based on the PharmaCare formulary, where appropriate.
BC PharmaCare is a provincial program and it cannot directly pay for eligible prescriptions filled 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.
FNHA clients who have paid for an eligible prescription filled out-of-province should be encouraged to request reimbursement from PharmaCare by using this Out-Of-Province Client Reimbursement Form with the official pharmacy receipts attached.
No, not all First Nations individuals in BC are eligible for PharmaCare Plan W. There are still a small number of NIHB clients in BC, 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 are covered by NIHB and not PharmaCare.
Please direct any questions related to FNHA Health Benefit enrollment to our FNHA client support representatives at 1-855-550-5454.
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