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First Nations and Inuit Health

Non-Insured Health Benefits Program Update

This update provides the latest news from the NIHB Program. It is intended to inform First Nations and Inuit clients, as well as their representative organizations, about their coverage as well as NIHB policy and benefit updates.

July 2016

Possible Canada Post Service Disruption

Most providers of program benefits are paid through direct deposit and payments to these providers would not be affected. They can continue to provide eligible services and bill the program in the usual manner.

Before accessing health benefits and services, clients are encouraged to contact their provider in advance of their appointment to confirm that:

  • the provider is enrolled with NIHB to receive direct payment;
  • the requested service is fully covered by NIHB; and
  • the provider will not request any up-front payment from the client.

Payments by cheque may be delayed. Health Canada encourages NIHB clients and health service providers to enrol for direct deposit as soon as possible. Direct deposit is a convenient and secure way to receive payment and will not be affected by any disruption in Canada Post mail delivery.

Health service providers of NIHB pharmacy, dental and medical supplies and equipment benefits should enrol for direct deposit with Express Scripts Canada (the program's claims processor for these benefits).

Regarding client reimbursements in urgent cases, please contact your local NIHB regional office.

For information on dental benefit reimbursements, please contact the Dental Predetermination Centre.

June 2016

Pharmacy Benefit Information

Change in the Listing Status of Bisphosphonates

Bisphosphonates are drugs that help strengthen bones, and are used in the treatment and prevention of osteoporosis and Paget disease. On March 10, 2016, oral bisphosphonate medications covered by the NIHB Program became open benefits. Claims for open benefits are processed automatically and do not require prior approval.

New Treatments Initiated by Pharmacists

Effective June 1, 2016, NIHB expanded options for pharmacists to initiate treatments for NIHB clients. These will allow easier access to many eligible products and medications. NIHB will accept prescriptions or written recommendations from pharmacists for claims that do not require prior approval, for the following types of benefits:

  • Prenatal vitamins
  • Medications for the prevention and treatment of nausea and vomiting in pregnancy
  • Emergency contraception ( the 'morning after pill')
  • Vaginal yeast infection treatments
  • Smoking cessation aids
  • Lice treatments
  • Allergy medications
  • Constipation treatments
  • Naloxone

Please remember that each province and territory has different regulations for health care providers, so you should talk to your local pharmacist to find out whether they can recommend or prescribe these treatments for you.

Coverage for Naloxone

Naloxone is an injectable medication that can reverse the effects of an overdose from opioid drugs (e.g. heroin, morphine, fentanyl). To improve access to this life-saving medication, NIHB has added naloxone as an open benefit on the Drug Benefit List.

If you or someone close to you may be at risk of an opioid overdose, it is recommended that you have a naloxone kit on hand, and be trained to use it. Public health programs in some provinces and territories now provide naloxone kits and training, so before claiming it through NIHB, you should check with your pharmacist to see if it is available through local health services.

Reminder - Change in Coverage of Medications to Treat Constipation

Docusate is a stool softener that may be prescribed for constipation. However, recent medical studies have found that docusate is not an effective medication to prevent or relieve constipation. Effective September 13, 2016, docusate products will not be covered by NIHB.

I'm taking stool softeners - now what do I do?

There are many different ways to treat constipation. Changes to your diet and how much physical activity you are getting may help, but sometimes medication is needed.

NIHB covers many other medications for constipation that are effective. Some of these work by making your stool bulkier and easier to pass. Others work by stimulating your bowels to move. Some draw water into you bowel making it easier to pass stools. Still others lubricate your bowel so that stool moves more easily through them. These medications come in many different forms: pills, liquids, powders, suppositories (that are inserted into the rectum), and enemas (fluid inserted through the rectum).

NIHB will pay for alternate treatments when prescribed or recommended by your pharmacist, nurse practitioner, physician, or other prescriber. Together with your healthcare provider, you can choose a treatment covered by NIHB that is right for you.

Where can I find more information?

For more information about coverage of other medications for constipation, consult the NIHB Drug Benefit List. You can review the evidence on stool softeners and other treatments for constipation at Canadian Agency for Drugs and Technologies in Health (CADTH).

Dental Benefit Information

NIHB Welcomes Dental Hygienists as Independent Service Providers

Effective June 1st, 2016, dental hygienists are able to submit claims to the Program as independent service providers, within their professional scope of practice. This applies in all regions except Quebec, Prince Edward Island, and the Territories, where professional regulations do not currently allow dental hygienists to practice independently.

NIHB welcomes dental hygienists to the Program, and is pleased to notify clients of this change that increases access to preventive oral health care for First Nations and Inuit.

May 2016

Important Message for NIHB Clients Evacuated Due to Alberta Forest Fires

If you need to refill or replace items that were covered by the NIHB Program, here is the information you need to know.

Medications

If you need to replace or refill a prescription for medication, please go to a local pharmacy and identify yourself as an NIHB client. If possible, please bring a copy of your prescription or medication packaging. If you don't know the details of your medication, your pharmacist may be able to look it up for you, or they can call the NIHB Drug Exception Centre.

Dental items (e.g. dentures)

Please contact the NIHB Dental Predetermination Centre at 1-855-618-6291.

Medical supplies and equipment and eyewear

If you are in Alberta or BC, please contact the NIHB Regional Office in Alberta at 1-800-232-7301.

If you have been relocated outside of Alberta, contact the NIHB Regional Office in the province where you currently are.

Medical transportation call centre

NIHB in the Alberta region has a medical transportation call centre that provides 24-hour service:

  • Telephone: 780-495-2708
  • Toll free: 1-800-514-7106

Mental health counselling

This benefit is intended to provide coverage for immediate psychological and emotional care to individuals in significant distress to stabilize their condition, minimize potential trauma from an acute life event, and, as appropriate, transition them to other mental health supports.

For assistance accessing mental health counselling, NIHB clients in Alberta should call:

  • Telephone: 780-495-3302
  • Toll free: 1-800-232-7301

March 2016

Pharmacy Benefit Information

Change in Coverage of Medications Used to Treat Constipation

Docusate is a stool softener that may be prescribed for constipation. However, recent medical studies have found that docusate is not an effective medication to prevent or relieve constipation. These findings were reported by the Canadian Association for Drugs and Technologies in Health (CADTH), an independent organization that provides research and information about the effectiveness of drugs and other medical treatments.

Because of this evidence, the NIHB Drugs and Therapeutics Advisory Committee (DTAC) recommended changing the listing status of docusate to non-benefit. Effective September 13, 2016, docusate products will not be covered by NIHB.

However, the NIHB Program covers many other products which are proven effective for the prevention or treatment of constipation. If you are taking a docusate medication, please talk to your health care provider about a different treatment option that is covered by NIHB.

Dental Benefit Information

Frequency Change for Plastic Partial Dentures

As of January 4, 2016, the NIHB Program has increased coverage for partial plastic (acrylic) dentures. NIHB will now consider coverage for replacement every 5 years (instead of every 8 years). The NIHB Dental Benefits Guide will be updated to reflect this change.

These tips will help to keep your plastic partial dentures comfortable and functional:

  • Rinse your mouth and dentures following meals to reduce staining and debris build-up on your dentures.
  • Remove dentures when you are sleeping so that your gums have a chance to 'breathe'.
  • Always keep plastic dentures in water when you have removed them for more than a few hours. Otherwise they will dry out, and crack more easily.
  • Never bite a partial denture into place in your mouth. Always place it with your fingers. Your jaws are very strong, and if the partial denture is not in exactly the correct position when biting, it can be damaged or your mouth can be injured.

Medical Supplies and Equipment Information

MS&E Northern Region Contact Information

Health Canada has two offices for the Northern Region: one in Ottawa, and the other in Whitehorse. The Northern Region office in Ottawa has a new address, and now manages MS&E benefits for all 3 territories. Clients from the Yukon, Nunavut or Northwest Territories who need to contact NIHB about MS&E (general inquiries or client reimbursements) may contact NIHB at the following telephone number and mailing address:

Telephone: 1-888-332-9222

Non-Insured Health Benefits
Northern Region, Health Canada
Tupper Building
2720 Riverside Drive, 4th Floor
Address Locator: 6604C
Ottawa, Ontario
K1A 0K9

Client Reimbursement for MS&E Items

If your MS&E provider is enrolled with NIHB, he or she should seek prior approval and bill NIHB directly for MS&E benefits. In some circumstances, such as when you are coordinating benefits with another health plan, or if your service provider is not enrolled with NIHB, you may have to pay up front for MS&E items. NIHB recommends contacting your MS&E provider in advance to ask whether the provider is registered with NIHB, and will bill the Program directly for items provided to you.

NIHB reimbursement will only be approved if the item is an eligible benefit and if you meet NIHB coverage criteria for the item. If you are paying up front for an MS&E item without prior approval, you should contact your Health Canada regional office to verify that the item is eligible for coverage.

When the cost of an MS&E item is fully covered through another public or private health care plan, and you have coverage through this plan, the NIHB Program will not approve requests for co-payment to upgrade the item. Client reimbursement will not be provided if you choose to pay out-of-pocket for the upgrade.

General Program Information

NIHB Navigators

NIHB Navigators help eligible clients to 'navigate' and access the NIHB Program. They are a resource for communities, organizations or individuals who need support or information on NIHB-related issues. Navigators are employed by regional First Nations organizations. Their roles and activities are adapted to meet regional needs, and generally include the following:

  • Increase understanding of the NIHB Program and share information on eligible benefits;
  • Help clients and communities to resolve NIHB-related issues;
  • Link with health departments and agencies to help improve client access to NIHB benefits and related health services.

More information about NIHB Navigators, including contact information, can be found on the Assembly of First Nations website.

January 2016

Dental Benefit Information

Preventive Dental Care

Preventive dental care includes taking good care of your teeth in order to prevent cavities, gum disease and other oral health problems. Regular brushing and flossing, eating a healthy diet, and visiting the dentist regularly are the most important things you can do to keep your mouth healthy.

The NIHB Program covers preventive dental services for adults and children. Children under 17 years of age are eligible for dental checkups, fluoride treatment and cleaning every six months. Clients 17 years of age and over are eligible for dental checkups and cleaning once a year.

It is recommended that children visit the dentist within six months of their first tooth coming in. Please check the NIHB Dental Benefits Guide for a complete list of eligible dental services and treatments.

General Program Information

Reminder for Parents and Guardians of NIHB-Eligible Infant Children

Parents and guardians of infant children are encouraged to apply for registered Indian status or seek recognition from their Inuit land claims organization as soon as possible to ensure their child's access to NIHB benefits. In order to allow parents time to register their children, infants up to one year of age may access most types of NIHB benefits under their parent or guardian who is NIHB eligible. After their first birthday, a child should have his or her own status or N number to ensure continued eligibility for NIHB benefits. For additional information visit the following section of the NIHB web site: To register an infant. For dental services only, contact the NIHB Dental Predetermination Centre if dental services are required for an unregistered infant under one year of age.

NIHB Registered Providers

Did you know that the NIHB Program works with over 30,000 private practice health service providers - such as dentists, pharmacists, optometrists and mental health counsellors - to help NIHB clients get the health benefits they need?

NIHB invites health service providers to register with the Program so that NIHB can pay them directly for eligible products and services provided to NIHB clients. These health service providers are not employees of Health Canada or the NIHB Program (with a few exceptions). NIHB has agreements with providers that encourage them to bill the Program directly, however in some cases providers will request that clients pay up front for their health benefits and services. To avoid an unexpected bill, it's best to confirm with your provider that they are registered with NIHB and will bill the Program directly, and that the product or service is fully covered by NIHB.

October 2015

Pharmacy Benefit Information

Change in How Often Pharmacists Can Dispense Benzodiazepines Under NIHB

The NIHB Program takes the issue of client safety and prescription drug abuse seriously. In December 2012, the Program began introducing a wide range of measures as part of a Prescription Drug Abuse Strategy.

As part of this strategy, on November 3, 2015 NIHB will change how often it will allow pharmacists to dispense benzodiazepines under the Program. Benzodiazepine medications are sedatives and can be used to treat anxiety or sleep disorders. Under the new policy, a maximum 30-day supply of benzodiazepines may be dispensed at a time. The policy will apply to all benzodiazepines that may be provided to you under the NIHB Program.

While this may mean some clients will need to see their pharmacists more often, it is an important step to ensuring that clients safely receive the medications they need.

Medical Supplies and Equipment Information

Billing for Medical Supplies and Equipment

MS&E providers should not request payment from you for eligible NIHB MS&E benefits that have been prior approved, except when you or your provider are coordinating benefits between another health care plan or insurance company and the NIHB Program.

If you have coverage through another plan, you may have to pay for the service and then submit your claim for reimbursement. This will depend on the terms and conditions of your other plan. You should submit your claim to the other plan first. Once they have processed your claim, you can submit any remaining eligible amounts to the NIHB Program (along with the statement of benefits from your other plan).

Short-Term Crisis Intervention Mental Health Counselling Information

Mental Health Crisis Counselling through Telehealth

Did you know that you can now access mental health counselling via telehealth? The NIHB Program may approve short-term crisis mental health counselling provided through telehealth, including telephone or video conferencing.

Many counsellors now offer this service to their clients. However, it is up to you and your counsellor to determine if counselling via telehealth is appropriate for you.

Keep in mind that if telehealth is offered to you, it is your choice. You can choose to use traditional face-to-face counselling if you prefer. If you choose telehealth, you may decide to resume face-to-face counselling at any time. It is recommended that the initial consultation be done face to face and prior approval must be obtained from NIHB before proceeding beyond the initial assessment.

The technology (i.e. video conferencing or telephone) used, and where you use it (e.g. nursing station, community health centre, or other) will be determined by your counsellor, based on your needs and what is available. Your counsellor will make sure that your privacy is protected at all times. Should you have questions or concerns, you should speak to your counsellor in advance so that he or she may address them fully.

For more information regarding NIHB guidelines for the use of telehealth, or to find a counselor in your region who may offer counselling by telehealth, please contact your Health Canada regional office.

Dental Benefit Information

Missed Dental Appointments

Dental associations have raised concerns with the NIHB Program about missed appointments. If you are unable to attend a scheduled dental appointment, please contact the dental clinic as soon as possible to reschedule your appointment for another time.

Please be aware that some clinics do charge a fee for missed appointments, and the NIHB Program does not cover these fees.

General Program Information

NIHB Client Reimbursement Form

The NIHB Program has revised its Client Reimbursement Request Form. The new form is easier to use and understand, and you may now fill out the form on-line. The form still needs to be printed and signed, before mailing or faxing back to NIHB for processing. Other changes to the client reimbursement process that are noted on the new form are:

  • Pharmacy reimbursement claims from all regions should now be mailed to the NIHB Drug Exception Centre, and
  • NIHB has set the minimum age for client reimbursement at 16 years of age. If the client is less than 16 years of age, a parent or legal guardian must sign the form, and will receive the reimbursement cheque.

June 2015

Pharmacy Benefit Information

Pharmacist Prescribing for Allergy Medications

Effective June 15, 2015, the NIHB Program will accept prescriptions from pharmacists for some medications to treat common allergy symptoms. The laws and regulations on pharmacist prescribing are not the same in every province. You can ask your local pharmacist if they are able to prescribe allergy medications.

For the treatment of runny nose due to allergies (known as "allergic rhinitis"), pharmacists may prescribe some oral and nasal spray medications. For the treatment of itchy, watery eyes (known as "allergic conjunctivitis"), the NIHB Program will accept prescriptions from pharmacists for medications such as eye drops and oral medications.

Change in the Listing Status of Buspirone

The medication buspirone is used to treat anxiety. It is less likely to be addictive, compared to some other anti-anxiety treatments, such as benzodiazepine medications (for example, diazepam). Effective April 21, 2015, buspirone became an open NIHB benefit. This gives NIHB clients and their doctors another treatment option for anxiety.

General Program Information

Government of Canada Direct Deposit - Information for NIHB Clients

What is the Direct Deposit Initiative?

The Direct Deposit Initiative is a new and modern way for the Government of Canada to make payments by switching from cheques, to depositing payments directly into your bank account. This way of making payments is secure, fast and reliable.

When will the Direct Deposit Initiative come into effect?

Direct deposit is now available and enrolment for direct deposit is underway. By April 1, 2016, most Government of Canada payments will be made by direct deposit.

Should all NIHB clients enroll for direct deposit?

Yes, all NIHB clients are encouraged to enroll for direct deposit if they expect to receive future payments from Health Canada.

However, payments for dental, pharmacy and/or medical supplies and equipment benefits are made through Express Scripts Canada on behalf of NIHB. These payments are not affected by the Government of Canada's Direct Deposit Initiative.

How do I enroll for direct deposit?

You must complete and submit a direct deposit enrolment form. You may have already received this form in the mail. You can download the form from the Health Canada website, or you can request a form by emailing DD@hc-sc.gc.ca.

Completed forms should be sent to:

In the Northern Territories, Ontario, Qubec and the Atlantic Provinces:

  • By email to DD@hc-sc.gc.ca
  • By fax to 613-954-3129
  • By regular mail to Accounting Operations East, 2932 Baseline Road, Tower C, Ottawa, ON, K1A 0K9

In Manitoba, Saskatchewan, Alberta and BC:

  • By email to vendor_codes_west@hc-sc.gc.ca
  • By fax to 204-594-8151
  • By regular mail to Accounting Operations West, 300-391 York Avenue, Winnipeg, MB, R3C 4W1

Are there any exceptions to direct deposit?

Yes. An exception can be made if an individual does not have a bank account.

To apply for an exception, you must fill out and submit the Direct Deposit Exception Form. You may have already received this form in the mail. You can also download the form from the Health Canada website, or you can request a form by emailing DD@hc-sc.gc.ca.

If you need more information about direct deposit enrolment or exceptions, you can call 1-800-815-0506.

March 2015

Pharmacy Benefit Information

Pharmacist Prescribing - Lice Treatment

In various provinces and territories, legislation and regulations now allow pharmacists to provide more services; besides filling prescriptions, they can also prescribe medication for some conditions, renew or extend an existing prescription when a doctor is unavailable, and sometimes modify a prescription to meet the patient's needs.

Pharmacists can be a great resource to get information on lice treatment. Effective March 15, 2015, the NIHB Program will cover medications prescribed by participating pharmacists for lice treatment.

The laws and regulations on pharmacist prescribing are not the same in every province. Please talk to your local pharmacist to find out which of the services above are available in your area.

Introduction of Dose Limits for Stimulants

Stimulants (for example, Dexedrine or Concerta) are medications used to treat attention disorders in children or adults. On February 25th, 2015 the NIHB Program set a new dose limit for stimulants to help ensure that clients are using these drugs safely. Dose limits are the maximum quantity of these drugs that a client can receive per day.

NIHB has contacted doctors whose clients exceed this dose limit to inform them of the change. If the doctor has provided NIHB with justification, some clients may continue to receive the higher dose.

Reduction in Dose Limits for Opioids and Benzodiazepines

To ensure the safety of clients, on March 4, 2015, the NIHB Program lowered dose limits for opioids and benzodiazepines.

Opioids are strong pain medications used to treat acute or chronic pain. NIHB is gradually reducing opioid dose limits to be in line with the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. This does not apply to clients who are taking opioids for cancer or palliative pain management.

Benzodiazepines (for example, diazepam) are used to treat numerous conditions including seizures, anxiety or insomnia. Beginning in 2013, the NIHB Program has been gradually reducing the benzodiazepine dose limit.

In some cases, clients may be exempt from these dose limits. Pharmacists should call the Drug Exception Centre when dose limits are reached.

Medical Supplies and Equipment Benefit Information

Improved Access to Ostomy Supplies

NIHB is changing its approval process for ostomy pouches and flanges to simplify access for clients who need them on a permanent basis. Effective March 16, 2015, clients with a permanent medical condition can be approved for two years instead of one. Your provider will help you with this approval.

Clients with a temporary medical condition will continue to require a yearly prescription.

Please be reminded that NIHB covers eligible claims which are not covered by other federal, provincial, territorial or private health insurance plans. When an NIHB-eligible client is also covered by another public or private health care plan, claims must be submitted to the other plan first.

Short-Term Crisis Intervention Mental Health Counselling (STCIMHC) Benefit Information

New Mental Health Counselling Publication

The NIHB Program's Short-Term Crisis Intervention Mental Health Counselling (STCIMHC) benefit provides coverage for crisis counselling services, when no other services are available. This benefit can help clients to access immediate care to stabilize a mental health crisis and, if necessary, to transition to longer-term mental health supports.

The NIHB Program collaborated with the Indian Residential Schools Resolution Health Support Program (IRS RHSP) to produce the Guide to Mental Health Counselling Services. This publication provides information to clients and providers on what services are eligible under each Program, and how these services or benefits can be accessed. It also establishes a common enrolment process for mental health counselling providers that enables them to provide services under either Program.

The Guide to Mental Health Counselling Services describes policies and procedures related to NIHB's STCIMHC benefit. Some key points for NIHB clients are:

  • The prior approval process for clients to access the STCIMHC benefit has been simplified;
  • In addition to 2 one-hour sessions for initial assessment, approval can now be provided for up to 15 one-hour counselling sessions per mental health crisis;
  • Counselling can now be provided through tele-health, with the client's agreement.

Please consult the Guide to Mental Health Counselling Services for a complete description of policies and procedures for the STCIMHC benefit and IRS RHS Program. You can contact your Health Canada regional office for a list of mental health providers who are enrolled with the NIHB Program and eligible to provide counselling services.

General Information

NIHB Navigators

NIHB Navigators help eligible clients to 'navigate' and access the NIHB Program. They are a resource for communities, organizations or individuals who need support or information on NIHB-related issues. Navigators are employed by regional First Nations organizations. Their roles and activities are adapted to meet regional needs, and generally include the following:

  • Increase understanding of the NIHB Program and share information on eligible benefits;
  • Help clients and communities to resolve NIHB-related issues;
  • Link with health departments and agencies to help improve client access to NIHB benefits and related health services.

More information about Next link will take you to another Web site NIHB Navigators, including contact information, can be found on the Assembly of First Nations website.

Indian Status Card and NIHB Client Eligibility

In order to submit benefit claims to NIHB, service providers require your NIHB client identification number. If you are a registered First Nations person, providers may ask to see your Indian status card because your Indian status registration number also serves as your NIHB client identification number.

An eligible First Nations NIHB client should not be denied services because the renewal date on their status card has passed. Service providers can still use your status registration number to submit your NIHB claim and eligibility will be verified by the claims processing system. Providers can also call the Express Scripts Canada call centre or the Health Canada regional office to verify your eligibility with NIHB.

If the renewal date has passed on your status card, or is about to, you should renew your card as soon as possible. All registered First Nations individuals can apply for the Secure Certificate of Indian Status by mail or by applying in person at any Aboriginal Affairs and Northern Development (AANDC) Regional Office. Next link will take you to another Web site Application forms and office locations can be found on the AANDC web site. Further information is available by calling 1-800-567-9604, emailing infopubs@aandc-aadnc.gc.ca or viewing the AANDC website. The paper-laminate version of the Certificate of Indian Status (CIS) continues to be issued by First Nation Indian Registration Administrators and First Nations individuals can call their local band office for further information.

Reminder for Parents and Guardians of NIHB-Eligible Infant Children

Parents and guardians of infant children are encouraged to apply for registered Indian status or seek recognition from their Inuit land claims organization as soon as possible to ensure access to NIHB benefits. For most types of benefits, NIHB will cover infants up to one year of age under their parent/guardian's NIHB client number. For dental services only, contact your Health Canada Regional Office if dental services are required for an unregistered infant under one year of age.

December 2014

Pharmacy Benefit Information

NIHB Drug Benefits Questions and Answers

1. How do I know what drugs are covered by the NIHB Program?

The Drug Benefit List (DBL) is a listing of the drugs covered as benefits by the NIHB Program. The DBL is published annually and updates are issued throughout the year. The listed drugs are generally used in a home or community setting (not in a hospital). A prescription from a licensed prescriber is required for any drug or product to be covered by NIHB.

2. How does the NIHB Program determine which drugs are eligible for coverage?

The NIHB Program receives recommendations on drug coverage from expert advisory groups, including the NIHB Drugs and Therapeutics Advisory Committee (DTAC) and the Canadian Drug Expert Committee. These groups provide unbiased advice based on current scientific knowledge, health care research and practice.

From time to time, specific drugs or products on the DBL may be removed or limited. This may be because a product has been removed from the Canadian market, or new research shows that the drug is not as safe or effective as previously believed. Consult Drug Review Process for more information.

3. What does it mean when a drug or product is listed as "limited use" (LU)?

Most drugs covered by NIHB are open benefits, and have no specific criteria for coverage. LU drugs are eligible for NIHB coverage only in certain circumstances. Some LU drugs have a maximum amount that can be prescribed within a certain time period. Others require approval by the NIHB Drug Exception Centre. A drug product may be listed as LU for a number of reasons:

  • If there is a risk that it could be misused;
  • If it can be effective only for certain conditions;
  • If it is usually a second or third choice for treatment, but may be required for some clients because of allergies or intolerance to other drugs;
  • If it is very costly and an effective alternative is available.

Consult Appendix A - Limited use benefits and criteria for a list of LU drugs and criteria.

If you have been prescribed a new drug by your health provider, please encourage them to consult the NIHB DBL to ensure that there are no special requirements or restrictions for coverage of the drug.

New Coverage for Prometrium

Prometrium is a medication that is given to replace the female hormone progesterone when the body is not making enough. Starting on December 1, 2014, Prometrium will become a LU benefit under the NIHB Program. It may be covered for women with post-menopausal symptoms who cannot take other medications, for pregnant women at risk of preterm labour, and for prevention of miscarriage. This change in listing status is based on a recommendation from the NIHB DTAC.

Change in Coverage for Vitamin E Products

As of January 15, 2015, vitamin E products will no longer be covered as an open benefit, and will become a LU benefit. This means that vitamin E supplements may still be covered if you have a condition that prevents your body from absorbing enough vitamin E. The vitamin E topical ointment will be removed from the DBL. These changes have been recommended by the NIHB DTAC. Research has shown that vitamin E is not helpful in treating medical conditions, except for vitamin E malabsorption. Also, research has shown that vitamin E can be harmful for some patients.

If you have been prescribed vitamin E products in the past, please speak with your health care provider to find out if you meet the new criteria for coverage, or to discuss other treatment options.

Change in Coverage for Acne Products

Benzoyl peroxide products are used to treat mild or moderate acne, and are available as gels, lotions, soaps or washes. Effective January 15, 2015, such products containing more than 5% benzoyl peroxide will no longer be covered by the NIHB Program. These products are not more effective for treating acne, and can be more irritating for the skin. Additional benzoyl peroxide products will be added in strengths of 2.5%.

Please speak with your health care provider if you have questions about acne treatment.

Dental Benefit Information

Dental Appeal Process

In many cases, clients may appeal a decision if their request for dental (including orthodontic) coverage is denied. Some dental procedures are excluded from coverage under the NIHB Program, and will not be considered for appeal. Consult Appendix D Appeal Process in the Dental Benefits Guide for more information.

Appeals require a letter from the client, parent or guardian and supporting documentation from the client's dental provider. Clients will need to work with their dental provider to obtain the documentation needed.

The appeal letter must be signed by the client, parent or guardian. The appeal package must be clearly marked "Appeals-Confidential" and must be mailed either by the client or the dental provider to the NIHB Dental Predetermination Centre at the following address:

For Dental Services:
Dental Predetermination Centre (Dental Services)
Non-Insured Health Benefits
First Nations and Inuit Health Branch
Health Canada
Address Locator 1902D
2nd Floor, Jeanne Mance Building
200 Eglantine Driveway
Ottawa, Ontario K1A 0K9

For Orthodontic Services:
Dental Predetermination Centre (Orthodontic Services)
Non-Insured Health Benefits
First Nations and Inuit Health Branch
Health Canada
Address Locator 1902C
2nd Floor, Jeanne Mance Building
200 Eglantine Driveway
Ottawa, ON K1A 0K9

Health Canada will provide clients with a written explanation of the decision at each level of appeal. If the client, parent or guardian has not heard within 30 business days of submitting the appeal, they may contact the NIHB Dental Predetermination Centre for an update (please see toll-free numbers below).

If an appeal is denied, clients may choose to access the next level of appeal. There are three levels of appeal available, the third being final. Clients should submit any additional or new supporting documentation from their dental providers with their appeals.

For complete information on the appeal process, consult the Procedure for Appeals on the NIHB's website.

Please note: Appeals for orthodontic services must be received by the DPC before the client reaches age 19. No orthodontic appeals will be considered after the client's 19th birthday.

General Information

Inuit Clients Residing in the Territories

If you are an NIHB-eligible Inuit client, you have an "N number"; this is a client identification number used by the NIHB Program to process your health benefits (such as drugs, dental care, vision care or medical supply and equipment benefits). For eligible Inuit living in the NWT or Nunavut, this NIHB identification number is linked to your Territorial Health Card to make benefit claims easier. If you plan to travel (for medical or other reasons), please keep in mind that health care providers outside of your home territory may not know that they can use your Territorial Health Card number to file your NIHB benefits claim. Knowing your "N number" is the easiest way to get the benefits that you need; make sure to know it or write it down so you can give it to health service providers (along with a piece of photo identification) if you need to claim NIHB-eligible benefits while you are away. If you don't know your "N number", you can find it by calling the NIHB Program regional office at the numbers listed below or on the Contact Us page of our website.

For more information on Inuit client eligibility, refer to section 2.1 on page 3 of the Inuit client handbook.

October 2014

Pharmacy Benefit Information

Increased Coverage for Smoking Cessation Products

Smoking cessation therapies are used to help people quit smoking. NIHB clients are now eligible to receive up to three courses of treatment of these products, up from two, in a 12-month period. The three courses include:

  • Two 12-week courses of nicotine replacement therapy (e.g. patches)
  • One 12-week course of treatment, like gums, lozenges, and inhalers, that are intended to be taken as needed.

The Program also covers Zyban and Champix, which are medications taken by mouth that are used to help people quit smoking.

Please discuss with your health care provider to determine the right products and therapies for you. In some provinces, your pharmacist can prescribe smoking cessation products for you.

Improving Access to Suboxone to Help Treat Drug Addictions

Suboxone and methadone are two medications used to treat people who are dealing with drug addiction. Both drugs help with withdrawal symptoms and drug cravings.

Previously, the NIHB Program provided coverage for Suboxone in special circumstances. This included coverage for those who can't take methadone, whether due to lack of access or serious reactions to the medication.

As of September 15, 2014, the NIHB Program changed how it covers Suboxone to ensure that it is more readily available as a treatment option for clients. Health care providers now have the choice of prescribing Suboxone or methadone. NIHB encourages clients to work with their health care providers to decide their best treatment options. If your doctor thinks Suboxone is a better choice for your addiction treatment, he or she can ask NIHB to cover Suboxone for you.

Clients receiving coverage for Suboxone will be placed in the NIHB Prescription Monitoring Program (PMP), which has some additional requirements if you are also prescribed opioids, benzodiazepines, stimulants or gabapentin.

Your pharmacist has been informed of all of the details of the changes and will be ready to seek NIHB coverage when you bring in your prescription.

Questions and Answers on Suboxone

1. When did this change happen?

This change happened on September 15, 2014. Any Suboxone prescriptions brought to your pharmacy on and after that date will be eligible for coverage.

2. What will my doctor need to do to get Suboxone covered for me?

If your doctor thinks Suboxone is the best option for you, he or she will need to write a prescription. You must take the prescription to a pharmacist, who will need to call the NIHB Program to provide any additional information required to process your claim. Given that Suboxone doses are normally witnessed in a pharmacy, the NIHB Program will continue to verify community supports are in place before approving coverage for clients living in remote communities where there are no pharmacists available.

3. Can I get Medical Transportation benefits to get my Suboxone?

Suboxone doses are normally witnessed in a pharmacy for a certain period of time when a client first starts to take this medication. Depending on the situation, NIHB may provide Medical Transportation benefits to clients who do not have access to Suboxone locally, so that it can be witnessed. However, the NIHB Program does not provide Medical Transportation benefits for clients simply to pick up their prescriptions.

If you would like more information about Medical Transportation benefits related to Suboxone treatment, please speak with your nearest Health Canada regional office.

Change in Coverage for Topical Antiseptics

The NIHB Program is removing some antiseptics from its Drug Benefit List as of November 3, 2014. These include:

  • hydrogen peroxide
  • triclosan 0.5% (Adasept)
  • aluminium benzethonum (Buro Sol)
  • chlorhexidine/isopropyl alcohol 2% and 4% (Stanhexidine)
  • hexachlorophene 3% (Phisohex)
  • povidone iodine 10% (Betadine)

Alcohol swabs will continue to be covered.

These changes are based on a recommendation from the NIHB Drugs and Therapeutics Advisory Committee (DTAC) due to a concern that overuse of these products could be harmful. Going forward, the Program may consider antiseptics for some clients on a case-by-case basis.

Your doctor can request coverage from NIHB if he/she thinks this is the right option for you.

Change in Coverage for Calcium and Vitamin D Combination Products

The recommended dose for combination calcium and vitamin D products is at least 500mg of calcium and 400 IU of vitamin D or higher. Therefore, NIHB will be removing all lower dose combinations of these products from the NIHB Drug Benefit List as of November 3, 2014.

Ensuring Safe Access to Kadian (a type of opioid)

As of November 17, 2014, the NIHB Program is changing the way it covers Kadian, a medication used to treat chronic pain as well as drug addiction. This change means that if your doctor thinks Kadian is the right option for you, he or she will need to provide the NIHB Program with additional information when requesting coverage. These changes ensure clients have safe and appropriate access to drugs like Kadian.

Why NIHB Encourages Clients to Use the Generic Version of Medications

Many medications in Canada are available in both brand name and generic versions. A generic version of a drug must have the same active ingredients in the same amounts, and work the same way in the body as the brand name drug. Health Canada reviews and approves all drugs before they can be sold in Canada. When a generic product is put on the market, it means that Health Canada has found it to be the same as the brand name drug and that it works the same way.

Generic drugs cost less than brand name drugs. The NIHB Program pays for the best priced medications on the market, which is usually the generic version. It is very common for public and private drug plans in Canada to cover generic drugs. Generic drugs help keep drug benefit coverage affordable and sustainable.

NIHB is aware that some clients cannot take certain medications. Should you experience a negative reaction to a generic drug, or any medication, please speak with your pharmacist or doctor.

Dental Benefit Information

Avoiding Unexpected Charges at the Dentist

Not all dentists participate in the NIHB Program. This means some dentists may ask clients to pay for some or all of the dental services provided before they leave the dental office. To avoid an unexpected bill, it's best to call your dentist's office and ask the following questions before making an appointment or accepting treatment:

  • I have dental coverage under the Non-Insured Health Benefits Program. Will the dentist send the bill directly to NIHB?
  • Is this procedure fully covered by NIHB?
  • Has my treatment plan been approved by the NIHB Dental Predetermination Centre?

To get the most coverage possible, clients must tell their dental providers about any other health insurance they have (e.g. a medical plan through work).

Clients who pay for their dental services have one year to submit their claims to NIHB for reimbursement. For information on how to submit a claim, please visit: NIHB Client Reimbursement Request Form.

September 2014

Pharmacy Benefit Information

Improving Access to Suboxone to Help Treat Drug Addictions

Suboxone and methadone are two medications used to treat people who are dealing with drug addiction. Both drugs help with withdrawal symptoms and drug cravings.

Currently, the Non-Insured Health Benefits (NIHB) Program provides coverage for Suboxone in special circumstances. This includes coverage for those who can't take methadone, whether due to lack of access or serious reactions to the medication.

As of September 15, 2014, the NIHB Program will change how it covers Suboxone to ensure that it is more readily available as a treatment option for clients. Health care providers will have the choice of prescribing Suboxone or methadone. NIHB encourages clients to work with their health care providers to decide their best treatment options. If your doctor thinks Suboxone is a better choice for your addiction treatment, he or she can ask NIHB to cover Suboxone for you.

For clients receiving coverage for Suboxone, the NIHB Program will continue to ensure appropriate access to drugs of potential misuse, including certain pain medications, sedatives and stimulants.

Your pharmacist has been informed of all of the details of the changes and will be ready to seek NIHB coverage when you bring in your prescription.

Questions and Answers on Suboxone

1. When will this change happen?

This change will happen September 15, 2014. Any prescriptions brought to your pharmacy on and after that date will be eligible for Suboxone coverage.

2. What will my doctor need to do to get Suboxone covered for me?

If you doctor thinks Suboxone is the best option for you, he or she will need to write a prescription. You must take the prescription to a pharmacist, who will need to call the NIHB Program to provide any additional information required to process your claim.

Given that Suboxone doses are normally witnessed in a pharmacy, the NIHB Program will continue to verify community supports are in place before approving coverage for clients living in remote communities where there are no pharmacists available.

3. Can I get Medical Transportation benefits to get my Suboxone?

The NIHB Program does not provide Medical Transportation benefits for clients to pick up their prescriptions. However, given that Suboxone doses are normally witnessed in a pharmacy when treatment begins, the Program is reviewing its Medical Transportation Policy to ensure that there are no barriers to accessing this medication.

Should you have any questions about Medical Transportation benefits related to Suboxone treatment, please speak with your nearest Health Canada regional office.

August 2014

Pharmacy Benefit Information

New NIHB Coverage of Blood Glucose Test Strips - Quebec Region

Testing blood sugar at home using test strips and a meter is common practice for many people with diabetes. However, research has shown that self-monitoring of blood glucose may have limited benefits for many clients who do not take insulin to manage their diabetes.

Based on best evidence, including recommendations from the Next link will take you to another Web site Canadian Agency for Drugs and Technologies in Health (CADTH), NIHB is introducing changes to the number of blood glucose test strips it will cover for clients with diabetes. The new policy bases the number of test strips on the medications the client is using to manage their diabetes. There will be no change in coverage for clients on insulin. However, clients managing their diabetes only through oral medication and/or diet and lifestyle changes will see their coverage for test strips reduced. NIHB recognizes this is a change in practice for some individuals. The goal is to ensure clients continue to have access to the test strips they need, while encouraging proper blood glucose testing.

This policy change will be implemented in the Quebec region on September 4, 2014. It is being introduced in a phased approach, which began with:

  • Atlantic region on November 4, 2013
  • Ontario region on January 6, 2014
  • Northern region on March 3, 2014
  • Alberta region on April 7, 2014
  • Saskatchewan region on June 2, 2014

The NIHB Program will continue to provide an update on specific implementation dates in each region when the information becomes available.

NIHB recognizes that there may be circumstances that may require some clients to test more frequently than is normally recommended. Clients are encouraged to speak with their health care providers if they have questions or concerns about how to monitor their blood glucose levels.

The number of test strips that will be covered by the NIHB Program will depend on the client's medical treatment:

  • Client under the age of 21 who use insulin will automatically be approved to use up to 800 test strips per 100 days if their pharmacy contacts the Drug Exception Centre.
  • Clients managing diabetes with insulin will be allowed 500 test strips per 100 days. A client can test up to five times per day.
  • Clients managing diabetes with diabetes medication with a high risk of causing low blood sugarFootnote 2 will be allowed 400 test strips per 365 days. A client can test once daily.
  • Clients managing diabetes with diabetes medication with a low risk of causing low blood sugarFootnote 3 will be allowed 200 test strips per 365 days. A client can test three to four times per week.
  • Clients managing diabetes with diet/lifestyle therapy only (no insulin or diabetes medications) will be allowed 200 test strips per 365 days. A client can test three to four times per week.

Clients under age 21 who use insulin will be automatically approved to use up to 800 strips per 100 days if their pharmacy contacts the Drug Exception Center. This policy change will improve access to test strips for clients under 21 through a more streamlined process.

These new limits encourage clients to monitor their blood sugar with meaning and discuss their readings with their pharmacist and diabetes care team. This means that clients will likely test less often which is a benefit to their lifestyle but the testing that is done will be used to make better decisions with their healthcare providers about their diet, exercise plan and/or medications. These discussions also give good opportunities to review the blood glucose monitoring technique to ensure adequate blood drop size which promotes accuracy of the reading and reduces waste of test strips. Remember that test strips have an expiry date and clients can review storage recommendations of blood glucose test strips with their pharmacists to also promote accuracy.

Additional Information About Blood Glucose Testing

Clients are encouraged to read "A Guide for NIHB Clients on Blood Glucose Test Strips," adapted from CADTH. This brochure is also available via Next link will take you to another Web site CADTH's website.

Questions and Answers About NIHB's Coverage of Blood Glucose Test Strips

July 2014

Pharmacy Benefit Information

Changes in coverage for Proton Pump Inhibitors (PPIs)

Proton pump inhibitors (PPIs) are a medication that reduces the amount of acid made by your stomach. They are commonly used to treat acid reflux (heartburn) and ulcers of the stomach. Some examples include: Losec, Pantoloc and Prevacid.

The Canadian Optimal Medication Prescribing and Utilization Service (COMPUS), an expert committee, has produced a report that says that all PPIs work equally well.

Based on this evidence and expert recommendations, starting July 21, 2014, the NIHB Program will no longer cover the following:

  • Losec 10MG Tablets (Omeprazole Delayed Release 10MG Tablets)
  • Losec 10MG Capsules (Omeprazole Delayed Release 10MG Capsules)
  • Tecta 40MG Tablets (Pantoprazole Magnesium Enteric Coated 40MG Tablets)

For clients who are currently claiming one of these medications through the NIHB Program, your claims will continue to be processed.

For other NIHB clients, the NIHB Program covers many other PPIs. Please talk to your Doctor, and visit the NIHB Drug Benefit List (DBL) for more information about the specific PPIs that are covered.

June 2014

Pharmacy Benefit Information

Pharmacist Prescribing

In various provinces and territories, legislation and regulations now allow pharmacists to provide more services; in addition to filling prescriptions they can also prescribe medication for some conditions, renew or extend an existing prescription when a doctor is unavailable and sometimes modify the prescription to meet the patient's needs.

Effective June 15th, 2014, the NIHB Program will cover medications prescribed by participating pharmacists for certain women's health issues, as well as to assist clients who are trying to stop smoking. The NIHB Program will cover prescriptions from your pharmacist for:

  • prenatal vitamins;
  • medications for the prevention and treatment of nausea and vomiting in pregnancy;
  • emergency contraception;
  • vaginal candidiasis; and
  • smoking cessation ("stop smoking") aids (e.g. nicotine gum or patches).

The laws and regulations on pharmacists prescribing are not the same in every province. Please talk to your local pharmacist to find out which of the services above are available in your area.

Pharmacists can be a great resource to advise you on the medications above, and provide other valuable advice about drug therapy.

New NIHB Coverage of Blood Glucose Test Strips - Saskatchewan Region

Testing blood sugar using test strips and a meter is common practice for many people with diabetes. However, research has shown that if you manage diabetes by diet alone or with pills you can self-test less often without harming your health.

Based on this evidence, NIHB is introducing changes to the number of blood glucose test strips it will cover for clients with diabetes. The new policy bases the number of test strips on the medications the client is using to manage their diabetes. There will be no change in coverage for clients on insulin. However, clients managing their diabetes only through oral medication and/or diet and lifestyle changes will see their coverage for test strips reduced. NIHB recognizes this is a change in practice for some individuals. The goal is to ensure clients continue to have access to the test strips they need, while encouraging proper blood glucose testing.

This policy change was implemented in the Saskatchewan region on June 2, 2014. It is being introduced in a phased approach, which began with:

  • Atlantic region on November 4, 2013
  • Ontario region on January 6, 2014
  • Northern region on March 3, 2014
  • Alberta region on April 7, 2014

The NIHB Program will continue to provide an update on specific implementation dates in each region as the information becomes available.

NIHB recognizes that there may be circumstances that may require some clients to test more frequently than is normally recommended. Clients are encouraged to speak with their health care providers if they have questions or concerns about how to monitor their blood glucose levels.

The number of test strips that will be covered by the NIHB Program will depend on the client's medical treatment:

  • Clients managing diabetes with insulin will be allowed 500 test strips per 100 days. A client can test up to five times per day.
  • Clients managing diabetes with diabetes medication with a high risk of causing low blood sugar will be allowed 400 test strips per 365 days. A client can test once daily.
  • Clients managing diabetes with diabetes medication with a low risk of causing low blood sugar will be allowed 200 test strips per 365 days. A client can test three to four times per week.
  • Clients managing diabetes with diet/lifestyle therapy only (no insulin or diabetes medications) will be allowed 200 test strips per 365 days. A client can test three to four times per week.

Clients under age 21 who use insulin will be automatically approved to use up to 800 strips per 100 days if their pharmacy contacts the Drug Exception Center. This policy change will improve access to test strips for clients under 21 through a more streamlined process.

These new limits encourage clients to monitor their blood sugar with meaning and discuss their readings with their pharmacist and diabetes care team. This means that clients will likely test less often which is a benefit to their lifestyle but the testing that is done will be used to make better decisions with their healthcare providers about their diet, exercise plan and/or medications. These discussions also give good opportunities to review the blood glucose monitoring technique to ensure adequate blood drop size which promotes accuracy of the reading and reduces waste of test strips. Remember that test strips have an expiry date and clients can review storage recommendations of blood glucose test strips with their pharmacists to also promote accuracy.

Additional Information About Blood Glucose Testing

Clients are encouraged to read "A Guide for NIHB Clients on Blood Glucose Test Strips," adapted from the Canadian Agency for Drugs and Technologies in Health (CADTH), attached to this newsletter. This brochure is also available via Next link will take you to another Web site CADTH's website.

Questions and Answers About NIHB's Coverage of Blood Glucose Test Strips

Dental Benefit Information

The Non-Insured Health Benefits Dental Predetermination Centre

As of September 1, 2013, the NIHB Program completed its centralization of administrative processing and review of dental claims at its headquarters in Ottawa. During the transition period, there have been some delays in processing requests, and the NIHB Program would like to thank clients for their patience during this transition period.

Turn-around times for processing predetermination (prior approval) of dental claims continues to improve each week, as we work toward our goal of a ten (10) business day standard. The NIHB Program is committed to continual improvement in service delivery.

Predetermination no longer required on replacements of standard complete dentures

Predetermination (or prior approval), is no longer required for replacements of standard complete dentures as long as the existing complete denture is at least eight (8) years old. This will reduce the wait time for clients who need to replace standard complete dentures. Please discuss with your dental provider for more information on whether you are eligible for coverage under the NIHB Program before starting the treatment.

What Are My Responsibilities?

Coverage by another health plan or program

Many people have health coverage (e.g. coverage of prescriptions or dental services) under more than one benefit plan - for example, health coverage through an employer. When submitting a claim, make sure to confirm the details of all your health insurance plans with the health service provider. This will allow them to submit the claims to the right plan in the right order. For NIHB eligible benefits, the NIHB Program will cover any remaining eligible amount not covered by your other plan(s).

When there is a change in your coverage status, in order to avoid any delays in receiving benefits, inform your health service provider so they can update the information in your file.

For more information regarding coordinating benefits for pharmacy, vision and medical supplies and equipment, when there is coverage by more than one benefit plan, please visit the Health Canada website: "Coordination of Benefits Information for Non-Insured Health Benefits (NIHB) Clients - August 2012".

For information regarding coordinating benefits for dental, please visit the Health Canada website: "Section 4.0 Payment and Reimbursement of Dental Benefits Guide: Non-Insured Health Benefits Program - March 2014".

May 2014

General Program Information

2012/2013 Non-Insured Health Benefits (NIHB) Annual Report

The 2012/2013 NIHB Annual Report provides national and regional data on the Program's clients, spending, and benefit use.

Highlights include:

  • As of March 31, 2013, the total number of eligible clients was 926,044, an increase of 3.3% over March 2012. Of the total client population, 883,133 (95.4%) were First Nations while 42,911 (4.6%) were Inuit.
  • Ontario region had the largest number of eligible clients (21.3% of the national total population), followed by Manitoba region (15.6%) and Saskatchewan region (15.3%).
  • In 2012/2013, the total cost of the NIHB Program was $1.1 billion. This total included $462.7 million spent on pharmacy benefits, $351.4 million on medical transportation benefits and $222.7 million on dental benefits.

Guide for Inuit on Non-Insured Health Benefits

Your Health Benefits - A Guide for Inuit to Access Non-Insured Health Benefits is a user-friendly guide for Inuit on the benefits that are available to them under Health Canada's Non-Insured Health Benefits (NIHB) Program, the Nunatsiavut Government Non-Insured Health Benefits (NIHB) Program, and Nunavik's Insured/Non-Insured Health Benefits (INIHB) Program. The guide explains who is eligible for each program, the benefits covered and how to access them, the procedure for appeals, and who to contact for additional information. It was developed jointly by Health Canada and the Inuit Tapiriit Kanatami.

Ontario Regional Office Move

The Health Canada Ontario Regional office has moved to a new address:

First Nations and Inuit Health Branch
Ontario Region, NIHB
Sir Charles Tupper Building
2720 Riverside Drive, 4th Floor
Postal Locator: 6604D
Ottawa, Ontario K1A 0K9

To ensure a smooth transfer, all telephone numbers will remain the same including the toll-free client information line (1-800-640-0642).

Dental Benefit Information

Updated Dental Benefit Guide

The NIHB Program has updated its Dental Benefit Guide.

This Guide explains how dental benefits are covered under the NIHB Program. Clients are encouraged to speak with the NIHB Dental Predetermination Centre at 1-855-618-6291 (dental services) or 1-866-227-0943 (orthodontic services) for questions about their coverage. In addition, clients should discuss their treatment plans and related dental coverage under NIHB with their dental providers.

March 2014

Pharmacy Benefit Information

Gabapentin Dose Limit Change

Gabapentin also known as Neurontin, is a medication used to manage conditions such as epilepsy and chronic pain.

On March 4, 2013, the NIHB Program placed a dose limit of 5000 mg per day for all clients on gabapentin. This is higher than the maximum recommended daily dose; however, a transition period was permitted for clients on high doses of gabapentin to meet this new dose limit.

On February 3, 2014, the NIHB Program further reduced the coverage limit on gabapentin to 4000 mg per day.

The NIHB Program's Drug Benefit List provides various other options for the treatment of epilepsy and chronic pain.

Change in How Often Pharmacists May Dispense Strong Pain Medications (Opioids) Under NIHB

The NIHB Program takes the issue of client safety and prescription drug abuse seriously. In December 2012, the Program began introducing a wide-range of measures as part of a Prescription Drug Abuse Strategy.

As part of this strategy, NIHB has changed how often it will allow pharmacists to dispense strong pain medications, called opioids, under the Program. Under the new policy, a maximum 30-day supply of opioids may be dispensed at a time. The policy applies to all opioids covered under NIHB, as well those that are covered only on a case-by-case basis.

While this may mean some clients will need to see their pharmacists more often, it is an important step to ensuring clients receive the medications they need without being put at-risk.

Change in ASA Coverage (acetylsalicylic acid/ Aspirin)

ASA is acetylsalicylic acid, commonly known as Aspirin. ASA is mostly used by adults to keep their blood thin when they have a heart condition. It should not be given to a child or teenager, before speaking with a doctor. Using ASA during a viral illness, like the flu or chicken pox, has been strongly linked with the development of Reye's Syndrome, a rare disease that can be fatal.

NIHB covers two dosages of ASA tablets: 80 mg and 81 mg. While ASA 81mg tablets will remain open benefits to NIHB clients of all ages, as of March 17, 2014, coverage of ASA 80 mg tablets will be limited to clients who are 21 years of age and younger. This change allows for continued access to ASA 80 mg tablets in children who have special health conditions.

Change in Coverage of Lancing Devices

Lancing devices are used for blood sampling in blood glucose testing for diabetics. These devices are provided free of charge as a kit with any new glucometer.

As of March 31, 2014, these devices will become an excluded benefit. Excluded benefits are not covered under the Program and cannot be appealed. Claims for lancing devices with a date of service on or after March 31, 2014, will be rejected. If a replacement is needed, the manufacturer can mail a lancing device directly to the client's home or pharmacy.

Coverage will remain for diabetic test strips and lancets as these are not provided free of charge from the manufacturer. A lancet is the needle or blade at the tip of a lancing device that is used to prick a finger for a blood test.

New NIHB Coverage of Blood Glucose Test Strips - Alberta Region

Testing blood sugar at home using test strips and a meter is common practice for many people with diabetes. However, research has shown that self-monitoring of blood glucose may have limited benefits for many clients who do not take insulin to manage their diabetes.

Based on best evidence, including recommendations from the Next link will take you to another Web site Canadian Agency for Drugs and Technologies in Health (CADTH), NIHB is introducing changes to the number of blood glucose test strips it will cover for clients with diabetes. The new policy bases the number of test strips on the medications the client is using to manage their diabetes. There will be no change in coverage for clients on insulin. However, clients managing their diabetes only through oral medication and/or diet and lifestyle changes will see their coverage for test strips reduced. NIHB recognizes this is a change in practice for some individuals. The goal is to ensure clients continue to have access to the test strips they need, while encouraging proper blood glucose testing.

This policy change will be implemented in Alberta region on April 7, 2014. It is being introduced in a phased approach, which began with:

  • Atlantic region on November 4, 2013
  • Ontario region on January 6, 2014
  • Northern region on March 3, 2014

The NIHB Program will continue to provide an update on specific implementation dates in each region when the information becomes available.

NIHB recognizes that there may be circumstances that may require some clients to test more frequently than is normally recommended. Clients are encouraged to speak with their health care providers if they have questions or concerns about how to monitor their blood glucose levels.

The number of test strips that will be covered by the NIHB Program will depend on the client's medical treatment:

  • Clients managing diabetes with insulin will be allowed 500 test strips per 100 days. A client can test up to five times per day.
  • Clients managing diabetes with diabetes medication with a high risk of causing low blood sugarFootnote 2 will be allowed 400 test strips per 365 days. A client can test once daily.
  • Clients managing diabetes with diabetes medication with a low risk of causing low blood sugarFootnote 3 will be allowed 200 test strips per 365 days. A client can test three to four times per week.
  • Clients managing diabetes with diet/lifestyle therapy only (no insulin or diabetes medications) will be allowed 200 test strips per 365 days. A client can test three to four times per week.
Additional Information About Blood Glucose Testing

Clients are encouraged to read "A Guide for NIHB Clients on Blood Glucose Test Strips," adapted from CADTH. This brochure is also available via Next link will take you to another Web site CADTH's website.

Questions and Answers About NIHB's Coverage of Blood Glucose Test Strips

Dental Benefit Information

What to include in a Client Reimbursement Request for Dental Benefits

Sometimes clients will pay for dental services and will need to be reimbursed by the NIHB Program. Here are the steps to follow:

  • Step 1: If you have other dental coverage, send your claim to your other dental plan first

    Clients who have dental coverage under another plan or program must submit their claims to their other payers first. The other payer will provide a detailed statement called an "explanation of benefits." Clients must send this document to NIHB so the Program can coordinate benefits with the other plan.

  • Step 2: Prepare your claim package for NIHB

    There are two forms clients can use to submit dental reimbursement claims, either a NIHB Client Reimbursement Request Form or a NIHB Dental Claim Form (Dent-29). The NIHB Dental Claim Form (Dent-29) can be obtained from your provider's office.

    Option 1:

    • Complete and sign a NIHB Client Reimbursement Request Form and include the following documents in your claim package:
    • ONE of the following forms, which can be obtained from your provider's office:
      • Association des Chirurgiens Dentistes du Qubec Dental Claim and Treatment Plan Form; or
      • Standard Dental Claim Form; or
      • Canadian Association of Orthodontics Information Form
    • Original receipts
    • Explanation of benefits statement from any other plan or program, if applicable. In such situations, a copy of the original receipt will be accepted, as the primary insurer may require the original.

    Option 2:

    • Complete and sign a NIHB Dental Claim Form (Dent-29) and include the following documents in your claim package:
    • Original receipts
    • Explanation of benefits statement from any other plan or program, if applicable. In such situations, a copy of the original receipt will be accepted, as the primary insurer may require the original.
  • Step 3: Mail your claim package to the NIHB Dental Predetermination Centre

    Note: First Nations clients residing in BC should direct their reimbursement requests to the Next link will take you to another Web site First Nations Health Authority in British Columbia.

    If the claim is for dental services, please send it to:
    NIHB Dental Predetermination Centre
    Dental Services
    Non-Insured Health Benefits Program
    First Nations and Inuit Health Branch, Health Canada
    Address Locator 1902D, 2nd Floor, Jeanne Mance Building
    200 Eglantine Driveway, Tunney's Pasture
    Ottawa, ON K1A 0K9
    Toll-Free Phone: 1-855-618-6291
    Toll-Free Fax: 1-855-618-6290

    If the claim is for orthodontic services, please send it to:
    NIHB Dental Predetermination Centre
    Orthodontic Services
    Non-Insured Health Benefits Program
    First Nations and Inuit Health Branch, Health Canada
    Address Locator 1902C, 2nd Floor, Jeanne Mance Building
    200 Eglantine Driveway, Tunney's Pasture
    Ottawa, ON K1A 0K9
    Toll-Free Phone: 1-866-227-0943
    Toll-Free Fax: 1-866-227-0957

Accepted Receipts for Dental Claims

Clients who need to be reimbursed by NIHB for a dental treatment are reminded to only send original receipt(s) from their dental providers as proof of payment.

Or, clients may send NIHB a copy of their original receipt(s) with their "explanation of benefits" when they are coordinating a claim from their other insurer.

However, credit card and debit (Interac) slips are not accepted. Please do not send bank account or credit card statements, such as your monthly Visa statement. These statements contain personal and banking information that should not be shared and will be securely destroyed if they are sent to NIHB.

What Are My Responsibilities?

NIHB Coverage for Children Less Than One Year of Age

Children are automatically covered under the NIHB Program if they are less than one year old and have an eligible parent who is registered for NIHB benefits.

However, parents are encouraged to register their child (First Nations) or have their child recognized (Inuit), before the child's first birthday. This is to ensure the child's coverage can continue smoothly, under his own identification number. Please contact one of the following organizations:

First Nations
Inuit Residing in the Northwest Territories and Nunavut
  • The Land Claim Organization to have your child recognized, such as Nunavut Tunngavik Inc. (NTI) at 1-888-646-0006 or Inuvialuit Regional Corporation (IRC) at 1-855-777-7011
    and
  • The Territorial Department of Health and Social Services to obtain a health care number
Inuit Residing outside of the Northwest Territories and Nunavut
  • The Land Claim Organization to have your child recognized, such as Nunavut Tunngavik Inc. (NTI) at 1-888-646-0006 or Inuvialuit Regional Corporation (IRC) at 1-855-777-7011;
    and
  • The Health Canada Regional office to obtain a Client Identification Number for the NIHB Program

The Importance of Keeping Your Personal Information Up-To-Date in the Indian Registration System (IRS)

Health providers must confirm a client's identity in order to provide services. If the information on a First Nations client's status card does not match the information on his health card (such as different names), the client may have problems accessing NIHB benefits.

First Nations clients are reminded to keep their personal information in the Indian Registration System (IRS) up-to-date. Health providers use IRS data to confirm First Nations clients' identities and clients may be denied access to benefits if the information they provide does not match the IRS.

To avoid being denied benefits, First Nations clients should contact their local Band Office or Next link will take you to another Web site Aboriginal Affairs and Northern Development Canada (AANDC)'s Registration Services Unit at 1-800-567-9604 to update the IRS whenever changes occur to their personal information, such as name changes.

February 2014

Pharmacy Benefit Information

Change in How Often Pharmacists May Dispense Strong Pain Medications (Opioids) Under NIHB

The NIHB Program takes the issue of client safety and prescription drug abuse seriously. In December 2012, the Program began introducing a wide-range of measures as part of a Prescription Drug Abuse Strategy.

As part of this strategy, NIHB has changed how often it will allow pharmacists to dispense strong pain medications (opioids) under the Program. Under the new policy, a maximum 30-day supply of opioids may be dispensed at a time. The policy applies to all opioids covered under NIHB, as well those that are covered only on a case-by-case basis.

While this may mean some clients will need to see their pharmacists more often, it is an important step to ensuring clients receive the medications they need without being put at-risk.

New NIHB Coverage of Blood Glucose Test Strips - Northern Region

Testing blood sugar at home using test strips and a meter is common practice for many people with diabetes. However, research has shown that self-monitoring of blood glucose may have limited benefits for many clients who do not take insulin to manage their diabetes.

Based on best evidence, including recommendations from the Next link will take you to another Web site Canadian Agency for Drugs and Technologies in Health (CADTH), NIHB is introducing changes to the number of blood glucose test strips it will cover for clients with diabetes. The new policy bases the number of test strips on the medications the client is using to manage their diabetes. There will be no change in coverage for clients on insulin. However, clients managing their diabetes only through oral medication and/or diet and lifestyle changes will see their coverage for test strips reduced. NIHB recognizes this is a change in practice for some individuals. The goal is to ensure clients continue to have access to the test strips they need, while encouraging proper blood glucose testing.

This new policy is being introduced in a phased approach, which began with the Atlantic region on November 4, 2013, and Ontario region on January 6, 2014.

This policy change will be implemented in Northern region on March 3, 2014.

Other regions will follow later in 2014.

The NIHB Program will continue to provide an update on specific implementation dates in each region when the information becomes available.

NIHB recognizes that there may be circumstances that may require some clients to test more frequently than is normally recommended. Clients are encouraged to speak with their health care providers if they have questions or concerns about how to monitor their blood glucose levels.

The number of test strips that will be covered by the NIHB Program will depend on the client's medical treatment:

  • Clients managing diabetes with insulin will be allowed 500 test strips per 100 days. A client can test up to five times per day.
  • Clients managing diabetes with diabetes medication with a high risk of causing low blood sugarFootnote 2 will be allowed 400 test strips per 365 days. A client can test once daily.
  • Clients managing diabetes with diabetes medication with a low risk of causing low blood sugarFootnote 3 will be allowed 200 test strips per 365 days. A client can test three to four times per week.
  • Clients managing diabetes with diet/lifestyle therapy only (no insulin or diabetes medications) will be allowed 200 test strips per 365 days. A client can test three to four times per week.
Additional Information About Blood Glucose Testing

Clients are encouraged to read "A Guide for NIHB Clients on Blood Glucose Test Strips," adapted from CADTH, attached to this newsletter. This brochure is also available via Next link will take you to another Web site CADTH's website.

Questions and Answers About NIHB's Coverage of Blood Glucose Test Strips

November 2013

Pharmacy Benefit Information

Talwin No longer Covered by NIHB

As of October 15, 2013, NIHB no longer provides coverage for Talwin, a drug used to treat pain, because Talwin does not work well for pain and has many side effects.

Clients who received Talwin 50 mg tablets anytime between July 15, 2013 and October 15, 2013 will have until January 15, 2014 to switch to a different drug. Clients who are currently taking this drug are encouraged to speak with their health providers.

Reducing Acetaminophen Dose Limits for Safety

To promote client safety, on October 15, 2013, the NIHB Program changed the dose limit for acetaminophen. This limits the quantity of acetaminophen clients can receive in a 100 day period. Acetaminophen is a drug typically used to relieve pain and fever. This limit applies to all acetaminophen products, as well as combination products like Tylenol 3 that contain acetaminophen and other drugs, like opioids.

Change in Coverage of Metadol

On November 18, 2013, NIHB changed its coverage of Metadol, a drug used to treat pain, and will only cover this drug:

  • For clients with moderate to severe cancer pain or chronic pain who have tried at least two other pain relievers first (e.g. long-acting opioids); or
  • For palliative patients who require the drug to help manage end-of-life pain.

Pharmacists may only dispense a maximum supply of 30 days at one time.

NIHB Will No Longer Cover Some Low Doses of Vitamin B12 Pills

As of January 13, 2014, the NIHB Program will no longer cover low doses (25 mcg, 50 mcg and 100 mcg pills) of vitamin B12 for any reason because evidence shows that low dosages of these products are not effective. However, the Program will continue to cover higher doses (250 mcg and 1000 mcg pills) for clients who are low in this vitamin and need it for their health.

Dental Benefit Information

NIHB Only Pays for Specific Types of Crowns (Caps)

The NIHB Program covers full metal as well as porcelain-fused-to-metal crowns, but not full porcelain crowns. While clients and their dental providers may choose whatever option they feel is best, clients may be asked to pay for items or services that are not covered under the Program. To avoid an unexpected bill, clients are advised to confirm their NIHB coverage through their dentists before starting treatment, so it is clear what the NIHB Program will pay for and what it will not.

For more information on the NIHB Crown Policy, please refer to the NIHB Dental Benefits Guide.

Where to Send Client Requests for Dental Claim Reimbursements, Predeterminations or Appeals

As of September 1, 2013, the NIHB Program completed its centralization of administrative processing and review of dental benefit claims at its headquarters in Ottawa. ClientsFootnote 1 should now send their requests to the NIHB Dental Predetermination Centre in Ottawa when they need to:

  • be reimbursed for their claims;
  • send a predetermination request (through their dental care providers); or
  • appeal a decision about their dental coverage.

The new contact information is:

  • NIHB Dental Predetermination Centre
    Non-Insured Health Benefits Program
    First Nations and Inuit Health Branch, Health Canada
    Address Locator 1902D, 2nd Floor, Jeanne Mance Building
    200 Eglantine Driveway, Tunney's Pasture
    Ottawa, ON K1A 0K9
  • Toll Free Phone #: 1-855-618-6291
    Toll Free Fax #: 1-855-618-6290

October 2013

New NIHB Coverage of Blood Glucose Test Strips - Atlantic and Ontario Regions

Testing blood sugar at home using test strips and a meter is common practice for many people with diabetes. However, research has shown that self-monitoring of blood glucose may have limited benefits for many patients who do not take insulin to manage their diabetes.

Based on best evidence, including recommendations from the Next link will take you to another Web site Canadian Agency for Drugs and Technologies in Health (CADTH), NIHB is introducing changes to the number of blood glucose test strips it will cover for clients with diabetes. The new policy bases the number of strips on the medications the client is using to manage their diabetes. There will be no change in coverage for clients on insulin. However, clients managing their diabetes only through oral medication and/or diet and lifestyle changes will see their coverage for test strips reduced. NIHB recognizes this is a change in practice for some individuals. The goal is to ensure clients continue to have access to the test strips they need, while encouraging proper blood glucose testing.

This policy change is being introduced in a phased approach, beginning with the Atlantic region on November 4, 2013 and Ontario region on January 6, 2014, with other regions to follow later in 2014. The NIHB Program will provide an update on specific implementation dates in each region when the information becomes available.

NIHB recognizes that there may be circumstances that may require some clients to test more frequently than is normally recommended. Clients are encouraged to speak with their health care providers if they have questions or concerns about how to monitor their blood glucose levels.

New NIHB Coverage of Blood Glucose Test Strips

The number of test strips that will be covered by the NIHB Program will depend on the client's medical treatment:

  • Clients managing diabetes with insulin will be allowed 500 test strips per 100 days. A client can test up to five times per day.
  • Clients managing diabetes with diabetes medication with a high risk of causing low blood sugarFootnote 2 will be allowed 400 test strips per 365 days. A client can test once daily.
  • Clients managing diabetes with diabetes medication with a low risk of causing low blood sugarFootnote 3 will be allowed 200 test strips per 365 days. A client can test three to four times per week.
  • Clients managing diabetes with diet/lifestyle therapy only (no insulin or diabetes medications) will be allowed 200 test strips per 365 days. A client can test three to four times per week.
Additional Information About Blood Glucose Testing

Clients are encouraged to read "A Guide for NIHB Clients on Blood Glucose Test Strips," adapted from CADTH. This brochure is also available via Next link will take you to another Web site CADTH's website.

Questions and Answers About NIHB's Coverage of Blood Glucose Test Strips

September 2013

General Program Information

Update Personal Information in the Indian Registration System (IRS)

Clients are reminded to keep their personal information in the Indian Registration System (IRS) up-to-date. Health providers use IRS data to confirm clients' identities and clients may be denied access to benefits if the information they provide does not match the IRS. To avoid being denied benefits, clients should contact their local Band or Next link will take you to another Web site Aboriginal Affairs and Northern Development Canada (AANDC) office to update the IRS whenever changes occur to their personal information, such as name changes.

Pharmacy Benefit Information

Drug Benefit List Update Now Available

NIHB's Drug Benefit List (DBL) tells prescribers, pharmacy providers and clients which drugs are covered under the Program. The DBL encourages the most optimal and cost-effective drug therapy for NIHB clients. An update to the benefit list is now available on Health Canada's website.

Prescription Drug Abuse Strategy

The following are pharmacy initiatives under NIHB's Prescription Drug Abuse strategy:

Reducing Benzodiazepine Doses for Safety

To protect clients' safety, on March 4, 2013, the NIHB Program placed a dose limit on benzodiazepines. This limits the maximum quantity of benzodiazepines clients can receive per day. Benzodiazepines are drugs typically used to treat anxiety or problems with falling asleep. The NIHB Program has begun reducing these limits every three months. The most recent reduction occurred on September 4, 2013.

Reducing Opioid Doses for Chronic Pain

On September 30, 2013, the NIHB Program will limit the dose of opioids, which are drugs used for pain. This dose limit will be the maximum quantity of the drug a client can receive per day.

NIHB will continue to monitor the use of opioids and adjust these dose limits as required. The Program relies on support from drug prescribers and pharmacists in its efforts to ensure the safer use of opioids among First Nations and Inuit clients.

June 2013

Highlights of NIHB's 2011/12 Annual Report

The NIHB Program released its 2011/12 annual report in April 2013. Highlights include:

  • In 2011/2012, the Program spent almost $1.1 billion on NIHB benefits. This included about $459 million on pharmacy benefits, the Program's largest expenditure, followed by NIHB medical transportation ($333 million) and dental benefits ($219 million).
  • As of March 2012, the Program had 896,624 eligible clients (95.4% First Nations and 4.6% Inuit clients).
  • The Atlantic Region had the largest increase in eligible clients, because of the registration of 21,419 new Qalipu Mi'kmaq First Nations clients.
  • Overall, the First Nations and Inuit client population is relatively young (average age of 31 years old) compared to the general Canadian population (average age of 40 years old).

A summary of the annual report is available on NIHB's website.

Health Canada will launch a streamlined version of its website in June 2013

Health Canada is removing or archiving outdated content on its website so Canadians can find the health- and safety-related information they are seeking quickly and easily. As a result, you may notice changes to the NIHB Program's web site. The purpose of this renewal is to improve users' online experience, making sure the most sought after information is accessible.

Pharmacy Benefit Information

Codeine and Children Under 12

Health Canada has reviewed the safety of prescription pain and cough medications containing codeine and is no longer recommending their use in children less than 12 years of age. As a result of this Next link will take you to another Web site recommendation, as of June 7, 2013, the NIHB Program will no longer provide coverage for codeine or codeine-containing products for children under 12. This recommendation is based on very rare cases of serious side effects and deaths in children that have been attributed to codeine, when given directly to a child, or to babies from breast milk. In 2008, Health Canada informed Next link will take you to another Web site healthcare professionals and the Next link will take you to another Web site public of the risk of codeine use in nursing mothers. Symptoms of a toxic reaction to codeine, or any other opioid, may include dizziness, confusion, extreme sleepiness, or sudden shortness of breath or difficulty breathing.

In addition, caution is advised regarding the use of codeine in any patients with breathing conditions, including children. Patients who experience difficulty breathing should seek immediate medical attention.

Clients with concerns or questions about treatment options should speak to their healthcare provider(s).

The following are pharmacy initiatives under NIHB's Prescription Drug Abuse strategy:

Pregabalin (Lyrica) Now Covered By NIHB for Certain Health Conditions

Pregabalin (Lyrica) is a drug used to treat certain types of neuropathic pain, also known as nerve pain. As of April 30, 2013, NIHB will cover pregabalin under the Program as a limited use drug. This means clients will need to meet certain criteria and receive approval from NIHB before coverage will be granted. In this case, pregabalin will only be available to clients with certain types of pain (i.e. nerve pain), and only if other drugs, like amitriptyline, don't work or cause side effects the client cannot tolerate.

Adding pregabalin as an NIHB benefit is part of the Program`s Prescription Drug Abuse strategy to provide health professionals and clients with alternatives to opioids for the treatment of nerve pain.

Meperidine (Demerol) Will No Longer Be Covered By NIHB

Meperidine (Demerol) is a drug similar to morphine that is intended to be used to treat moderate to severe pain on a short-term basis. Regular use of meperidine, even for medical purposes, may be harmful and can lead to physical dependence, a natural reaction that occurs when the body gets used to having a certain drug.

Until recently, the NIHB Program provided coverage of meperidine. However, due to safety concerns, as of July 9, 2013 the Program will no longer cover this drug. Clients are encouraged to consult their health prescribers prior to ending the use of this medication and to discuss pain management alternatives.

NIHB Is Expanding Safety Measures for Clients Taking Methadone in Saskatchewan

Methadone is a drug that can be used to help reduce withdrawal symptoms and drug cravings in people who are dealing with drug addiction. The NIHB Program is trying to ensure that clients taking methadone are not also provided potentially harmful doses of other drugs of abuse.

Since 2011, the NIHB Program has had measures in place in the Atlantic region where clients receiving methadone have restrictions for their opioids such as Tylenol 3 and their benzodiazepines such as Ativan. This approach has helped to protect clients' safety.

As of May 6, 2013, NIHB expanded these restrictive measures to Saskatchewan.

Drugs that are restricted when clients in Saskatchewan are also taking methadone include:

  • gabapentin such as Neurontin;
  • benzodiazepines such as Ativan;
  • stimulants such as Concerta; and
  • opioids such as Tylenol 3.

NIHB asks Saskatchewan clients who are taking methadone to choose one doctor to write all prescriptions for drugs monitored by NIHB. This helps to ensure that the client has an established relationship with a doctor who has complete information about the medications the client is accessing, and can help optimize the client's treatment while helping to prevent misuse. These measures for clients taking methadone will be expanded to other provinces at a later date.

Medical Supplies and Equipment Benefit Information

Improving Benefit Access for Clients with a Permanent Need for Incontinence Supplies

On April 1, 2013, NIHB changed its approval process to allow clients with a permanent medical condition to access incontinence items for two years instead of one year. Incontinence items include diapers, disposable liners and pull-ups. As part of the new approval process, the client's physician or nurse practitioner must indicate the client has a "permanent condition" directly on their prescription.

When a client with a permanent medical condition is approved for a two year period, it will reduce the time it takes for clients to receive these items because the provider will not need to contact the NIHB regional office as often for approval. During this period, providers can dispense the required items as per NIHB policy (450 items per three-month period).

Clients with a temporary medical condition will continue to require a yearly prescription.

Providers will need to seek prior approval from their local Health Canada regional office for clients who need more items than the Program's frequency guidelines allow.

March 2013

Pharmacy Benefit Information

Limiting Tiotropium (Spiriva) to Certain Health Conditions

Tiotropium, marketed under the brand name Spiriva, is a drug used to treat breathing problems in people with certain health conditions. Based on a recommendation by NIHB's Drugs and Therapeutics Advisory Committee (DTAC), the Program is limiting coverage of this drug to certain types of chronic obstructive pulmonary disease (COPD), a progressive disease (meaning it becomes worse over time) that makes it hard to breathe. NIHB no longer requires clients with moderate to severe COPD, like bronchitis and emphysema, to try another medication first, like Atrovent. This improves access for clients who will benefit most from this therapy.

Limiting Nabilone (Cesamet) to Certain Health Conditions

Nabilone, marketed under the brand name Cesamet, is used to manage nausea and vomiting due to cancer chemotherapy or radiation. Based on a recommendation by NIHB's DTAC, effective April 30, 2013, it will no longer be available as an open benefit. Instead, the Program is limiting coverage of this drug to treatment of:

  • Nausea and vomiting due to cancer chemotherapy or radiation; or
  • Clients eligible for NIHB's palliative care formulary (i.e. for relief of suffering of an incurable disease).
  • Coverage will be granted for a maximum of six months. If coverage is required beyond the initial six months, additional coverage may be reviewed on a case-by-case basis.

Prescription Drug Abuse Strategy

Prescription Drug Abuse Strategy Protects Clients' Safety

This is a follow-up to the articles on new NIHB Program restrictions for clients on high doses of benzodiazepines (e.g. sleeping and anxiety pills) and gabapentin (e.g. pills for pain) published in the Client Newsletter in January 2013. The NIHB Program has decided that the Gabapentin Monitoring Program (GMP) and Benzodiazepine Monitoring Program (BMP) will no longer be used to manage clients' restrictions of benzodiazepines and gabapentin. Instead, the Program will use the existing Prescription Monitoring Program as it deals with potential overuse of not only benzodiazepines and gabapentin, but also with opioids (e.g. pain killers) and stimulants (e.g. to treat attention disorders).

NIHB will not Cover Long Acting Oxycodone

Long acting oxycodone is used to treat moderate to severe pain when continuous, long term pain management is required. OxyContin, a long acting oxycodone drug, was discontinued in Canada in 2012. Following this withdrawal, generic oxycodone recently became available in Canada. The NIHB Program has concerns about the potential for misuse and abuse of this drug and will not include generic brands of long-acting oxycodone on its Drug Benefit List (DBL). These drugs will not be covered under any circumstance.

NIHB has taken action under its Prescription Drug Abuse Strategy to prevent and respond to potential misuses of prescription drugs so that First Nations and Inuit clients can access the medications they need without being put at risk. Alternative therapies are available for clients requiring long acting drugs in this family.

Claiming for Methadone, Opioids, Benzodiazepines and Stimulants

The NIHB Program will no longer accept manual claims for certain drugs like methadone, opioids, benzodiazepines and stimulants due to safety concerns. These drugs can be misused and abused and their use must be followed very carefully to ensure clients do not receive harmful doses. NIHB must receive these claims in the Program's electronic claims processing system at the point-of-sale (i.e. when prescriptions are filled at the pharmacy). This ensures accurate and timely monitoring of these drugs.

Prescription Drug Abuse Surveillance Strategy

NIHB's Prescription Drug Abuse Surveillance Strategy tracks how drugs like methadone, opioids, benzodiazepines and stimulants are prescribed and dispensed. NIHB has an electronic system that closely monitors claims for these drugs and lets health providers know if there is a concern. The goal of these measures is to protect clients' safety.

Medical Supplies and Equipment Benefit Information

New Prescribers Can Now Prescribe Custom-Made Shoes

As of March 1, 2013, the NIHB Program will allow podiatrists to prescribe custom-made shoes and orthotics, as well as modifications to off-the-shelf footwear. Clients continue to need a prescription from a general practitioner, nurse practitioner or podiatrist for a referral to a recognized NIHB footwear provider if they require these products. This policy change is meant to improve access to footwear benefits for clients.

January 2013

Prescription Drug Abuse Strategy Protects Clients' Safety

Drugs have the potential to help but also to harm. The NIHB Program takes client safety and prescription drug abuse very seriously. This is why the NIHB Program is implementing a number of changes to its pharmacy benefits under a Prescription Drug Abuse (PDA) strategy. This strategy includes a wide range of measures for the safety of eligible First Nations and Inuit clients. Please contact Health Canada's Regional Offices for more information on these Prescription Drug Abuse (PDA)-related initiatives.

New Restrictions for Clients on High Doses of Benzodiazepines

Benzodiazepines (for example Ativan) are drugs used to treat conditions such as anxiety and sleeplessness. Long term use of benzodiazepines raises safety concerns, especially when used in high doses. If a client's pattern of use of these drugs exceeds a safe threshold, the client will be requested to have one prescriber for all their benzodiazepines. When a client attempts to fill a prescription that exceeds the safe threshold, the pharmacy will receive a rejection message and be asked to call the NIHB Drug Exception Centre (DEC) for further information.

On March 4, 2013, the NIHB Program will place a dose limit on benzodiazepines. This limit will be initially set high (total dose of benzodiazepines of 120 mg per day) and will be lowered appropriately until an acceptable limit is reached. According to the product monograph for benzodiazepines, the recommended usual adult dose is up to 40 mg per day.

New Restrictions for Clients on High Doses of Gabapentin

Gabapentin is a drug used to manage conditions such as epilepsy or chronic pain and may be harmful if clients take more than the maximum recommended daily dose.

To ensure client safety, on January 3, 2013, clients receiving more than 5000 mg of gabapentin per day will be placed in the new Gabapentin Monitoring Program (GMP). These clients will be requested to have one prescriber for all their gabapentin.

On March 4, 2013, the NIHB Program will place a dose limit for all clients on gabapentin of 5000 mg per day. A transition period will be permitted for clients on high doses of gabapentin to meet this new dose limit.

Brand Name Ritalin no Longer Listed on the NIHB Drug Benefit List (DBL)

Ritalin is used to treat Attention Deficit Hyperactivity Disorder (ADHD). On January 3, 2013, the NIHB Program will no longer provide coverage for the brand name version of Ritalin (methylphenidate). The Program will continue to provide coverage for the generic version of Ritalin as well as other ADHD treatment options including Dexedrine and Concerta. These products will be available as open benefits therefore they will be covered without the pharmacy having to call the NIHB DEC.

Removal of brand and generic versions of Tylenol #4

On January 9, 2013, the NIHB Program will no longer provide coverage for Tylenol #4 or its generic versions. This decision is based on a recommendation by the NIHB Drugs and Therapeutics Advisory Committee.

Tylenol #4 is a pain killer which contains 300 mg of acetaminophen and 60 mg of codeine per tablet. When a client takes the maximum allowable number of tablets of Tylenol #4 or one of its generic versions available, they are getting more codeine per day than is recommended by recent Canadian treatment guidelines (600 mg). At these high doses, clients are being put at risk of serious adverse events.

Other options for the treatment of pain covered by the NIHB Program include over-the-counter (OTC) preparations of acetaminophen, OTC and prescription non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil, prescription codeine, morphine, hydromorphone or fentanyl patches as well as prescription medications for neuropathic pain, such as duloxetine (Cymbalta).

December 2012

Coordinating Benefits Under More Than One Plan

Many First Nations and Inuit people have health coverage under more than one benefit plan, such as from their province/territory (a public plan), their employer (a private plan) and the Non-Insured Health Benefits (NIHB) Program. If this is the case, all plans should be used when claiming for benefit expenses.

Making claims under more than one plan is called "coordination of benefits." Coordinating benefits means that clients are using the coverage that is available to them from all plans. For example, when NIHB clients go to a pharmacy to get a prescription filled, they need to tell their pharmacist about their other coverage. This enables the pharmacist to submit the claim to the right plan in the right order.

Some plans coordinate benefits electronically and the client's health provider will submit all of the information needed to coordinate the claim. Some plans require the client to pay for the item, service or prescription and mail-in the receipts. For NIHB eligible benefits, the Program will cover any remaining amount not covered by the other plan(s), up to the Program's maximums.

Clients can find more information about how to coordinate pharmacy benefits, as well as the NIHB Client Reimbursement Form in the Benefits Information section.

Pharmacy Benefit Information

Safety Measures for Benzodiazepines and other Drugs of Concern

November 19 marked the first day of National Addiction Awareness week. Health Canada's Non-Insured Health Benefits (NIHB) Program takes the issue of client safety and prescription drug abuse seriously. The NIHB Program is introducing a wide range of measures as part of a Prescription Drug Abuse Strategy to make sure that eligible First Nations and Inuit clients can get the medications they need without being put at risk.

Initial stages of NIHB's Prescription Drug Abuse Strategy will focus on benzodiazepines. Benzodiazepines are drugs sometimes used to treat conditions like anxiety and sleeplessness. Chronic or long time use of benzodiazepines raises safety concerns, especially when used in high doses. To protect clients' safety, starting in November 2012, NIHB began requiring clients receiving high doses to obtain them from one prescriber through the NIHB Benzodiazepine Monitoring Program. These clients will have forms sent to their pharmacy which they need to bring to the prescriber of their choice, who will become their only prescriber for benzodiazepines. In Quebec, the forms will be sent directly to the client's doctor. OnMarch 4, 2013, the NIHB Program will set a limit on the dose of benzodiazepines for which NIHB will provide coverage.

NIHB will also be expanding these safety measures to include opioids, and a dose limit will be gradually implemented. More detailed information regarding these strategies will be communicated in the future.

Birth Control Products

The Evra Patch, Nuvaring vaginal ring, and intrauterine devices (or IUDs) are birth control options. On November 5, 2012, the NIHB Program changed the listing status of both the Evra Patch and Nuvaring to open benefits. This means these products will be covered by the NIHB Program without prior approval. In addition, IUDs can now be obtained more often under NIHB. These changes make accessing these birth control options easier. Please note that exceptions to the above guidelines may be made on a case-by-case basis, as required.

Attention Deficit Hyperactivity Drugs

Concerta is a brand name drug taken once a day to treat Attention Deficit Hyperactivity Disorder (ADHD). On October 16, 2012, the NIHB Program began providing clients greater access to this drug, as well as the generic version, by moving them to open benefits. This means these products will be covered by the NIHB Program without prior approval.

Triptans for Migraines (e.g. Imitrex, Zomig)

Triptans are drugs used to treat migraine headaches. While these drugs are considered to be safe when used as directed, there can be serious problems if a person takes them too frequently. To protect the safety of clients, the NIHB Program is changing its coverage of Triptans to limit how much a client can receive in a month (12 units every 30 days). This limit was recommended by the Program's expert Drugs and Therapeutics Advisory Committee, and is consistent with other public drug plans in Canada.

There are many treatment options covered under the NIHB Program used to manage migraine headaches. These include over-the-counter drugs like acetaminophen (e.g. Tylenol) as well as many prescription drugs. Clients are encouraged to speak with their health care providers to determine the option(s) that best suit(s) their needs. For more details on the products that are available under the NIHB Program, please refer to the NIHB Drug Benefit List.

Emergency Dispense Process for Drugs

NIHB's Drug Exception Centre is responsible for granting approval for coverage of certain types of drugs. However, emergencies can happen at a time of the day or night when this Centre is closed. When emergencies occur, a pharmacist may give NIHB clients a four-day supply of certain drugs, when there is a medical need, and the client cannot wait for the Centre's approval. Please note that not all drugs are available through the emergency supply process.

NIHB's Drug Exception Centre will review the pharmacists' request for drug coverage as soon as possible. The pharmacist will be notified once a decision on approval is made for the remaining prescription.

More information on NIHB's emergency supply process is available in the Program's Provider Guide for Pharmacy Benefits.

Dental Benefit Information

Changes to NIHB's Dental Crown Policy

A crown is an artificial cap used to cover a damaged or decayed tooth. A crown is not considered an emergency dental service. The NIHB Program provides coverage for two types of crowns: porcelain fused to metal and metal crowns. These crowns have a good track record over several years and provide good resistance and function. The Program will consider coverage for a crown mainly when the tooth can no longer be restored with a filling, yet has enough healthy tooth structure to support it.

As of November 1, 2012, the NIHB Program implemented a frequency of one crown in any three year period per client. Clients are reminded that the NIHB crown policy, guidelines and criteria still apply and that predetermination (also known as prior approval) remains mandatory for all crown requests.

For more information on this crown policy, please see the NIHB Dental Benefits Guide.

NIHB's Updated Dental Benefits Guide

The NIHB Program would like to inform clients that, as of January 1, 2013, the NIHB Dental Policy Framework (2005) will no longer be available on the Health Canada website as it is no longer current.

Clients are encouraged to consult the NIHB Dental Benefits Guide, which contains the most up-to-date information on the NIHB Program and its policies relevant to dental providers and clients.

Medical Supplies and Equipment Benefit Information

Incontinence Supplies for Adults

Incontinence products include diapers, disposable liners and pull-ups. NIHB is changing its approval process to allow clients with a permanent medical condition to access these items for two years instead of one year.

When a client with a permanent medical condition is approved for a two year period, it will reduce the time it takes for clients to receive these items because the provider will not need to contact the NIHB regional office as often.

Clients with a temporary medical condition will continue to require a yearly prescription.

Providers will need to seek prior approval from NIHB for clients who need products more frequently than the Program's guidelines.

Footnotes

Footnote 1

First Nations clients residing in BC should direct these requests to the First Nations Health Authority in British Columbia.

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Footnote 2

Examples include: glyburide, gliclazide (Diamicron) and Starlix.

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Footnote 3

Examples include metformin, Glucobay, Actos, Onglyza, Januvia, Trajenta and Victoza

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