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.
PharmaCare and the FNHA have created a new PharmaCare plan "Plan W" for FNHA clients, to be implemented October 1, 2017. The plan offers 100% coverage of the eligible costs of drugs, dispensing fees, and pharmacy services. As of that date, FNHA clients will be covered by PharmaCare and subject to the same PharmaCare policies and processes as other BC residents. Plan W will become the first payer and primary pharmacy drug plan for eligible FNHA clients.
The small number of eligible medical supplies on the PharmaCare formulary will also be covered by PharmaCare (e.g. insulin pump and diabetes supplies). Over-the-Counter medications, and medical supplies and equipment (MS&E), which are currently provided through NIHB, will 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 which are not covered by PharmaCare.
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.
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 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.
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.
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