Drug Benefits
The Non-Insured Health Benefits (NIHB) Program funds prescription and
over-the-counter medications that are not covered by other private or
provincial/territorial health insurance plans.
What is covered?
The NIHB Program covers the 'lowest cost alternative drug' which is
commonly known as a generic drug. The policy of the NIHB Program is to
reimburse only the best price alternative or equivalent product in a
group of interchangeable drug products.
The NIHB Program will pay for prescription drugs with a higher cost
if the recipient cannot take the generic drug as a result of an adverse
reaction to the generic drug.
How do eligible recipients access drug benefits?
- Recipients must obtain a prescription from a physician or other licensed
prescriber;
- The prescription should be taken to a pharmacy to be filled. Or,
it can be taken to a nursing station, which may arrange to have the
prescription filled on behalf of the recipient at a local pharmacy;
- Recipients may contact
the Regional Office should they require more information.
Is there an appeal process when a benefit is not funded?
Eligible recipients can submit an appeal when funding for a benefit
is declined. Please refer to the Appeal
Procedures section.
Who can prescribe under the NIHB Program?
A doctor or other health professional licensed to prescribe by a province
or territory.
Who can provide drug benefits?
Drug benefits must be provided by a registered pharmacist.
Is prior approval required before billing the NIHB Program for
a prescription?
The NIHB Program maintains a comprehensive Drug Benefit List. In most
cases, the drugs that are prescribed are on the list and the pharmacist
can dispense them immediately.
However, the pharmacist must obtain approval when the:
- Drug is not on the NIHB Drug Benefit List;
- Physician has written 'no substitution' on the prescription;
- Drug is listed as a 'limited use drug' requiring prior approval;
or
- Drug is a 'maximum allowable' drug.
See the Drug/Pharmacy
Health Provider Information section for details on the benefit
policies, procedures and resources for health providers.
Resources
Visit the Reports and Publications section
to access a wide variety of Non-Insured Health Benefits documents.
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