Important changes in health benefits for FNHA clients

All First Nations Health Authority clients are now BC PharmaCare beneficiaries. Please note the following:

Eligibility (as of October 1, 2017)

• All FNHA clients who are eligible for the BC Medical Services Plan (MSP) are eligible for FNHA PharmaCare Plan W benefits.

• Most FNHA clients automatically have access to the FNHA PharmaCare Plan. 

• FNHA clients who do not yet have access to Plan W benefits are encouraged to contact FNHA.  

For additional eligibility information, click here.

Drug Benefit Lists

• Search the PharmaCare Plan W formulary or download the entire formulary.

• PharmaCare provides coverage of over-the-counter (OTC) items for FNHA clients. Please see the list of OTC items and non-drug OTC products available with Plan W. 

• To ensure continuity of therapies, NIHB is providing coverage for a select few items not found on the PharmaCare Plan W formulary. Please see the NIHB formulary for FNHA clients on Plan W. 

• A small percentage of clients have to adjust drug therapies to receive coverage under PharmaCare. FNHA clients taking drugs on this list are advised to speak with their health care provider to ensure they get the medications they need. 

• A small number of FNHA clients do not currently have access to the Pharmacare Plan W. Instead, these clients have their prescriptions covered by NIHB's parallel Plan W formulary. For specific information regarding manufacturer information, please reference the NIHB Drug Benefit List. 

Special Authorities

• Transitional Special Authorities (SAs) are in place to ensure continuity of therapies for FNHA clients.

• The expiry of transitional SAs are specific to each drug, but many SAs are indefinite.

• Details on the expiry of transitional SAs will be available in the PharmaCare Newsletters.

• Contact FNHA if a transitional SA was missed, or if an SA for a hepatitis C drug expiry date does not align with the prescribed treatment duration

Transitional Coverage Request Form

• For transitional coverage issues, pharmacists can bill the prescription to FNHA through an interim exceptional process by completing and faxing a Transitional Coverage Request form to FNHA

• This transitional coverage request allows pharmacists and prescribers the time to reassess/change a patient's medication for Plan W coverage

• This transitional coverage request form is a one-time fill per drug per patient, if appropriate

• Pharmacists will be reimbursed $10 in addition to the usual drug cost plus dispensing

Grandparented Therapies

• Exceptional SAs have been grandparented to allow continued coverage of drugs otherwise considered non-benefit

• The expiry of grandparented SAs is specific to each drug

• Contact FNHA if a patient was missed for grandparented coverage (e.g. no substitution products)

Travelling/Out-of-Province Claims

• FNHA clients filling prescriptions outside of BC will need to pay for their prescription and then apply for reimbursement. More information can be found on our client reimbursement page.

• Please work with your FNHA clients to ensure that they fill their prescriptions in BC prior to travelling out of province.

More Information

• Pharmacists can find further information in their Frequently Asked Questions, along with this reference guide to assist with drug coverage decisions.

• Prescribers (Physicians, Nurse Practitioners, and Midwives) can find further information in their Frequently Asked Questions.

• Call 1.855.550.5454 or contact FNHA via email at 

HealthBenefits@fnha.ca  for further information.

Updated December 4, 2017