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Pharmacy

​​​The FNHA Health Benefits program provides eligible clients:

• Specified drugs, including certain prescription drugs

• Over-the-counter (OTC) drugs

• Proprietary medicines

• ​Compounds - such as eye drops and skin creams; these mixtures prepared by the pharmacist

What is covered?

The majority of FNHA pharmacy benefits are administered through the BC PharmaCare program. Eligible FNHA clients will receive coverage for their prescription medications through PharmaCare Plan W. All drugs approved for coverage by PharmaCare Plan W are available on their formulary search, which can be found here.

Drugs that are not on the PharmaCare Plan W formulary may be approved for coverage as a Special Authority, when exceptional need is demonstrated. Special Authority requests must be initiated by a doctor or nurse practitioner. The following drug products are exclusions under the program:

• Household products (e.g. soap and shampoos)
• Anti-obesity drugs
• Cosmetics
• Alternative therapies (e.g. glucosamine and evening primrose oil)
• Megavitamins
• Drugs with investigational/ experimental status
• Vaccinations for travel
• Hair-growth stimulants
• Fertility agents and impotence drugs
• Select over-the-counter products
• ​Co​ugh preparations containing codeine

Accessing your Pharmacy Benefits

How do I access my pharmacy benefits? And how does payment work?

1. As an eligible FNHA client, you visit a physician/nurse practitioner
2. Your physician/nurse practitioner writes a prescription for you. 
3. You take your prescription to the pharmacy.
4. Your pharmacist will enter your benefit infor​mation into their point-of-sale-system, PharmaNet. 
5. Prescriptions will adjudicate first through PharmaCare Plan W. Any items not covered by PharmaCare can also be adjudicated through a third party provider and then NIHB, which will continue to cover a small number of items for First Nations in BC.  
6. If you are prescribed a specific medication not on the Plan W formulary, your prescriber (physician or nurse practitioner) can apply for Special Authority for that medication.
7. PharmaCare reviews the request and determines eligibility based on program guidelines. 
8. Once a Special Authority is approved, the information is entered into PharmaNet and your prescription can be filled.

An appeals procedure for Pharmacy is being finalized. Information about the appeals procedure will be posted on our website once it is available.

Do you have questions?

Contact us at:

HealthBenefits@fnha.ca 

or call 

1.855.550.5454


​​


​Quick Links

Drug Benefits for FNHA Clients is a list of resources for pharmacy providers.​


​FNHA Website​​PharmaCare Transition Information:​

http://www.fnha.ca/benefits/pharmacare-transition

​Browse ​FNHA's website for important information and ​documents.
​BCPhA eTraining Portalhttps://www.bcpharmacy.ca/education/etraining​Login with BCPhA email and password to access public and member-only courses.
​Transitional Coverage Request Formhttp://www.fnha.ca/Documents/FNHA-Transitional-Coverage-Request-Form​.pdf​This manual claim process allows payment of the claim and extra time to resolve a coverage issue.   Please contact FNHA if you have a case where you are uncertain of its appropriate use.
​FNHA-PharmaCare Coverage Continuity Guide​Pharmacist's Guide for RDP, LCD and Non Benefits:

https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/pharm_guide_co​vg_cont.pdf

​PharmaCare Coverage – Pharmacist's guide for RDP, LCA and Non-Benefits for FNHA clients.
​First Nations Health Benefits (Plan W) Over the Counter Benefits​List of OTC items listed as benefits specific to Plan W:

https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/planw-otc-meds.pdf

​This list of OTC items is specific for Plan W and is in addition to OTC items that are already PharmaCare benefits.

 

Note: some of these items may not yet appear on the PharmaCare Formulary Search tool.

​Pharmacist-Initiated OTC Treatments​List of Conditions Covered:

https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/pharm_initiated_otc.pdf

 

Processing Claims Information:

https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/newsletters/news17-010.pdf

​Treatments initiated by the pharmacist for select minor ailments can be reimbursed by Plan W. Claims should be entered into PharmaNet the same way as other prescriptions.
​Plan W Non-drug OTC Benefitshttps://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/pharmacies/product-identification-numbers/plan-w-non-drug-otc-benefits​This document contains PINs for general supplies; diabetic supplies; inhaler spacers; and IUDs.
​NIHB Residual List for FNHA Clients​Residual List:

http://www.fnha.ca/Documents/NIHB-Formulary-List-for-FNHA-Clients-Enrolled-in-Plan-W-Providers.PDF

 

Algorithm for Coverage:

https://www2.gov.bc.ca/assets/gov/health/health-drug-coverage/pharmacare/pharm_guide_covg_cont.pdf

​To ensure continuity of coverage, NIHB covers select prescription and non-prescription items not listed in Pharmacare Plan W. 
​NIHB Parallel Plan for FNHA clients not yet enrolled in Plan Whttp://www.fnha.ca/Documents/NIHB-Formulary-List-for-FNHA-Clients-Not-Enrolled-in-Plan-W.PDF​NIHB's Parallel Plan W for FNHA clients provides coverage for FNHA clients not yet enrolled in Plan W. 

 

Clients not yet enrolled in Plan W should be encouraged to call FNHA.

​Non-Insured Health Benefits Program Information​NIHB's Guide for Pharmacy Benefits:

https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/reports-publications/non-insured-health-benefits/guide-pharmacy-benefits-non-insured-benefits.html

 

NIHB Pharmacist Initiated Therapy:

https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/reports-publications/non-insured-health-benefits/guide-pharmacy-benefits-non-insured-benefits.html#chp3_13

 

ESC-NIHB Claims Submission Kit

http://provider.express-scripts.ca/pharmacy/claims-submission-kit

​These links provide information on the Indigenous Services Canada's rules and policies for claim submitted to and paid by NIHB.​



Plan​ W in PharmaCare Newsletters:​
October 4, 2018
  • • Submitting OTC Claims for Plan W Beneficiaries in Plan B Facilities
  • • Plan W covers ostomy supplies for FNHA clients
August 21, 2018
  • • Full Payment Policy & Plan W
  • • Basaglar covered as preferred insulin glargine brand
March 1, 2018
  • • Expiring Transitional SA's
  • • Exceptional & Limited Coverage Drugs
  • • Non-Drug OTC Benefits
  • • NIHB Residual Items
January 26, 2018
  • • Plan W Full Payment Policy
  • • Transitional SA Expiration Dates
November 14, 2017​
  • • Plan W compounds
  • • OTC reimbursements
  • • Claims issues for unregistered clients
October 17, 2017
  • • Plan W Formulary
  • • OTC Drug/Non-Drug Benefits
  • • Special Authorities
  • • Out-of-Province Claims
September 26, 2017
  • • PharmaCare Transition
  • • OTC Drug Benefits
  • • Devices, MS&E, BGTS
  • • Out-of-Province Claims
  • • Provincial Treatment Agencies
  • • Frequency of Dispensing
September 12, 2017
  • • MS&E Coverage
  • • Continuity of Coverage
August 8, 2017
  • •​ Transition to PharmaCare (Eligibility, Coverage, Payment Policy)​

 Do you have questions?

​Contact us at 

HealthBenefits@fnha.ca 

or call 

1-855-550-5454 ​(Toll Free)

 How was your experience?

​We want to hear from you about your experience with FNHA Health Benefits. Please take 5-10 minutes to fill out our survey here:

​Feedb​ack ​

​This client satisfaction survey will help us understand BC First Nations experiences accessing FNHA Health Benefits. We will use this information to improve the quality of our services.​​

Downlo​ad a print version of the FNHA Health Benefits Client Satisfaction Survey​

FNHA-Health-Benefits-Client-Satisfaction-Survey.jpg

Click here

​Client Satisfaction Survey FAQs

​Click here
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