First Nations Health Authority Clients

First Nations Health Benefits (Plan W)

 

Plan W covers 100% of eligible prescription costs and certain medical supplies, certain over-the-counter drugs, some natural health products, and pharmacy services. Plan W is funded by the First Nations Health Authority.

See more information on the general coverage policies that apply to all PharmaCare plans, including Plan W.

 

Who will be covered by the new PharmaCare plan?

You are eligible for coverage under the Plan W if you:

  • have active Medical Services Plan (MSP) coverage, and
  • are a registered Indian under the Indian Act, or are a child of less than 1 year of age who has at least one  parent who is a registered Indian under the Indian Act, and
  • are not an individual who is eligible to receive comprehensive drug coverage through:
    • a treaty and land claims agreement under the Constitution Act, 1982 (Canada) (unless that treaty and land claims agreement has been identified by the provincial Minister of Health as not resulting in ineligibility), or
    • a written contribution arrangement between a First Nations organization and a government or province of Canada under which the government provides funding and which has been identified by the provincial Minister of Health as resulting in ineligibility for enrolment.

Your eligibility for the plan is confirmed by the FNHA; PharmaCare cannot authorize coverage under Plan W.

If FNHA paid for your Medical Services Plan (MSP) premiums before Oct. 1, 2017, and you meet the eligibility criteria above, you automatically have coverage under Plan W as of Oct.1, 2017. You do not need to apply.

If you meet the eligibility criteria above, but FNHA is not paying your MSP premiums (for instance, if it is paid by your employer or by Veterans Affairs Canada), please contact the FNHA.

To enrol in MSP, just contact your FNHA representative as usual.

The FNHA and BC PharmaCare have been working together to make sure the switch to PharmaCare Plan W is as seamless as possible. As a result, most clients will see no change in the way their coverage is delivered at their pharmacy.

If the FNHA paid for your prescription claims through NIHB before Oct. 1, 2017, PharmaCare will cover your claims after that date. You do not need to do anything to get coverage under Plan W.

After Oct. 1, 2017, your pharmacist will submit your prescription claim online as usual and your BC PharmaCare coverage will be applied immediately.

PharmaCare Plan W covers most OTC medications previously covered by NIHB, under similar rules.

Therefore, to be eligible for coverage for many OTCs, you will need a prescription from your physician, nurse practitioner, or midwife. For other OTCs, treatment can be initiated by your pharmacist. In both cases, to be eligible for coverage your pharmacist must submit a claim to PharmaCare at the time of purchase.

See the list of OTC items that may be initiated by pharmacist. OTCs not on the list require a prescription.

NIHB will continue to cover medical supplies and equipment that require NIHB prior authorization. See the list of NIHB MS&E benefits.

PharmaCare covers the following medical supplies and equipment for all eligible PharmaCare beneficiaries, such as:

In addition, for Plan W only, PharmaCare covers:

  • Lancets
  • Blood and urine ketone strips
  • Alcohol wipes/pads
  • Needles and syringes (not restricted to those for insulin injection)
  • Inhaler spacers
  • Intrauterine Devices (IUDs)

What about medications purchased in other provinces?

PharmaCare is a provincial drug program, so Plan W cannot cover drug purchases made outside the province automatically. We recommend you plan ahead and obtain the maximum allowable amount of medication under the PharmaCare Travel Supply Policy before you leave B.C.

If you must purchase medication in another province, you will need to send an Out-of-Province Claim form to PharmaCare and include your original pharmacy receipt.

Don’t have the original pharmacy receipt? Request an official duplicate from the pharmacy. Note that till receipts or photocopies cannot be accepted.

Out-of-Province Border Pharmacies

Some, but not all, border pharmacies are enrolled in BC PharmaCare. Although border pharmacies enrolled in PharmaCare cannot submit your claim for immediate online adjudication, they can submit a paper claim to PharmaCare on your behalf. Please check with the pharmacy before you fill your prescription.

What about over-the-counter (OTC) medications and devices purchased outside B.C.?

Whether you purchase an OTC medication or a device at a B.C. pharmacy or an out-of-province pharmacy, it must be processed as a prescription. For out-of-province purchases, this means you will have an official prescription receipt that you can submit to PharmaCare for reimbursement.

Yes. FNHA clients are eligible for other PharmaCare plans if they meet the criteria for the plan(s).

For information on what PharmaCare covers or about PharmaCare policies, contact Health Insurance BC.

To enrol in MSP, or if you have concerns about your coverage, call the FNHA toll-free Health Benefits Support line at 1 855 550 5454 or email the FNHA at HealthBenefits@fnha.ca.