What is covered with Great West Life?
- Prescription drugs listed on the Nisga’a Drug List (Formulary)
- Prescriptions not on the Benefits list may be eligible for Special Authorization (Exceptions Committee review)
- Over the Counter Medication and certain products such as Ensure are not a benefit, however, they are approved on an exceptional basis based on the medical condition of clients, for example, for cancer or palliative clients.
What does your drug plan cover?
It covers the “lowest cost alternative drug” which is commonly known as an Enhanced Generic Drug. Great West Life has a process for clients who require the name brand. Innovicares also assists with name brand coverage. The NVHA can assist with acquiring Innovicares coverage for brand name coverage.
How do you access drug benefits?
- Visit your doctor or any other licensed prescriber for a prescription.
- Bring the prescription to a pharmacy or to your local health centre who may arrange to have the prescription sent to a local pharmacy.
In most cases, the drugs that are prescribed are on the formulary and the pharmacist can provide them right away. In some cases, the pharmacist may have to obtain approval from the NVHA before filling the prescription. The pharmacist must obtain approval when:
- The drug you have been prescribed is not on the formulary. It then becomes an exceptional drug request.
- The pharmacist will then have to go through the exceptional drug approval process.
- The NVHA will refer some exceptional drug requests to Pharmacare for coverage. Pharmacare is a provincial program that BC citizens can apply to for specific drugs on their formulary. Pharmacare coverage has helped NVHA with annual costs in this program.
Exception Drug Process
The pharmacist will fax the exception drug request to the NIHB to initiate the process. If needed, NIHB will request more information about the prescription, and requisite information from the doctor. Complete drug exception requests will be reviewed and a decision is made on the requests. If approved, the decision is communicated to Great West Life who then have their own process before notifying the pharmacist of the approval. It can take a couple of days on some approvals.