About this BenefitWhat My Plan CoversHow Do I Access Coverage?What My Plan Does Not CoverSpecialty Pharmacy ItemsTravelling Outside BC?Appeals
Prescription and over-the-counter medication can be an important part of treating illness, and are one of the many ways to help people with chronic conditions live healthier, longer, and more fulfilling lives.
Health Benefits has partnered with BC PharmaCare and Pacific Blue Cross (PBC) to offer a comprehensive pharmacy plan to First Nations in BC.
You must be enrolled with Health Benefits to access pharmacy benefits. This is especially important if you live in a community near the Yukon or Alberta borders. If you are in a border community, check with pharmacy to find out if the pharmacy is registered with PBC.
If you need to enroll for the first time, or want to check your enrollment, please have your status number ready and call Health Benefits at 1-855-550-5454.
Your plan covers the following pharmacy items:
• prescription drugs• over-the-counter drugs • non-drug over-the-counter items (eg, lancets for diabetics’ use) • the Shingrix® vaccine
Most pharmacy items and services are covered through a partnership with BC PharmaCare, which has different plans for different needs. PharmaCare Plan W (for Wellness) is the plan for First Nations people living in BC. For more information, see Pharmacare and PharmaCare Plan W on the BC government website.
To learn more about what is covered, you can explore:
• the Plan W drug list for prescription items (learn how to use the PharmaCare formulary by watching this helpful video)• a list of over-the-counter medications• a list of over-the-counter items• the supplementary drug list of prescription items processed through PBC
Summary of Diabetes Drugs, Insulins and Supplies Coverage for FNHA Clients (fact sheet)
How to access coverage for the Shingrix® vaccine (fact sheet)
When you need medication or pharmacy items, the best way to avoid out-of-pocket costs is to talk to your pharmacist about which items are fully covered by your plan.
1. See a prescriber to get a prescription for your medication or pharmacy item.
2. Some medications need Special Authority from PharmaCare for coverage. Ask your prescriber if your medication requires Special Authority.
3. Talk to your pharmacist about which medications and items are fully covered by your plan. Most pharmacy items are either fully covered or have a fully-covered alternative. If you are being asked to pay for your medication, ask the pharmacist if there is an alternative covered by your plan.
4. The pharmacist will dispense your medication and bill Plan W or PBC directly.
If you have any questions about your pharmacy plan, how to access coverage, or why a claim was denied, call Health Benefits at 1-855-550-5454.
There are provincial agencies that support all BC residents who have cancer, an organ transplant, kidney disease, or HIV/AIDS. The BC Cancer Agency, BC Transplant, BC Renal Agency and the BC Centre for Excellence in HIV/AIDS provide specialty pharmacy items to all BC residents living with these specific illnesses or conditions. Talk to your doctor about coverage through a provincial agency if you think you may be eligible.
Are you planning to travel outside of BC?
1. Plan ahead and make sure you have enough medication with you to last your whole trip. PharmaCare allows you to refill a prescription early when you plan to travel outside BC. If you need to fill a prescription in another province, you will have to pay out of pocket and request reimbursement from PharmaCare.
2. If you are taking a medication that is dispensed daily at your pharmacy, please call Health Benefits and let us know you will be travelling to another province so that we can arrange coverage for you.
3. You can call Health Benefits at 1-855-550-5454 for support if you experience any problems at a pharmacy outside of BC.
Some items and services are considered Exclusions. Exclusions cannot be covered as an exception and cannot be appealed. Pharmacy benefit Exclusions include, but are not limited to:
• alternative therapies (eg, glucosamine and evening primrose oil)• anti-obesity drugs• cannabis• clinic, physician and hospital fees, including for completing a form• drugs with investigational or experimental status• fertility agents and impotence drugs• prescriptions written by a veterinarian • vaccinations (the Shingrix® is covered; see What My Plan Covers, above)
Note that the flu shot is free. For more information about getting a flu shot, see Influenza (Flu).
You can also call Health Benefits at 1-855-550-5454 to learn more about what is covered.
When a coverage request for a medication or pharmacy item has been denied, you have the right to appeal the decision. Items and services that are Exclusions cannot be appealed. See the Appeals page for more information about the appeals process.
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