The FNHA Health Benefits program provides eligible clients:
What is covered?
All drugs approved for coverage by the FNHA Health Benefits program are listed on the NIHB Drug Benefit List. The list is published once per year with updates every three months. The complete Drug Benefit List and program policies can be found on the NIHB website at: www.hc-sc.gc.ca/fniah-spnia/nihb-ssna/index-eng.php
Drugs that are not on the Drug Benefit List may be approved for coverage on a case-by-case basis when an exceptional need is demonstrated. These requests must go through the Drug Exception Center and are forwarded by your pharmacy.
The following drug products are exclusions under the program:\
Accessing your Pharmacy Benefits
How do I access my pharmacy benefits? And how does payment work?
1. Visit your eligible FNHA client visits physician.
2. Your doctor writes a prescription for you.
3. You take your prescription to the pharmacy.
4. Your pharmacist will enter your benefit information into her/his point of sale system for prescription drugs that are on the Non-Insured Health Benefits (NIHB) Drug List.
5. Pharmacists will phone the NIHB Drug Exception Centre and provide your benefit information and benefit costs for drugs that are not on the list or are limited use drugs.
6. The Physician is contacted by NIHB to complete form outlining medical requirements of the drug. The Physician returns the form to NIHB. The request and supporting information is forwarded to a Medical Consultant for a professional opinion on medical requirements.
7. NIHB Drug Exception Centre reviews the request and determines eligibility based on program guidelines.
8. Drug Exception Centre provides pharmacy with prior approval details by telephone.
FNHA client receives medication. Pharmacist forwards claim to claims payer.
Non-Insured Health Benefits (NIHB) Drug List
The Drug Benefit List is a list of the drugs provided as benefits under the NIHB Program. The Drug Benefit List is updated regularly and published annually.
A prescription from a licensed practitioner is needed for any drug on the list to be processed as a benefit.
You can review the Drug Benefits List 2016 here.
Appeals Procedure for Pharmacy
APPEAL Level 1:
NIHB Drug Exception Centre
First Nations and Inuit Health Branch, Health Canada
200 Eglantine Driveway, 2nd floor
Tunney's Pasture, Postal Locator 1902D
Ottawa, ON - K1A 0K9
APPEAL Level 2:
Benefit Management and Review Services Division
Non-Insured Health Benefits
First Nations and Inuit Health Branch
APPEAL Level 3:
First Nations Health Authority
#501 – 100 Park Royal South
West Vancouver, BC - V7T 1A2
1.800.317.7878 (Toll Free)
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