The purpose of the pharmaceutical program is to assist clients to obtain prescriptive drugs through a medical prescription.
- Multivitamins are a benefit for infants only and up to 2 years of age.
- Single entity vitamins in therapeutic strength for specific pathology may be provided as deemed necessary by NVHA medical professionals.
- Prenatal vitamins are a benefit for females aged 12 to 50 years.
- Accutane requires prior approvals for females between 12 to 50 no prior approval for other NIHB clients.
- Over the Counter (OTC) medications are not a benefit under the Nisga’a Formulary, and may be purchased without a prescription.
What is covered?
- Drugs listed on the Nisga’a Formulary.
- Drugs that are considered medically necessary, and prescribed by the treating physician or dentist.
- Prescription drugs are those products with a drug identification number (DIN) for which a prescription is required by provincial or federal law.
- Proprietary Medicines are products bearing general products (GP) numbers which may be purchased without a prescription. These products are not a benefit under the Nisga’a NIHB Program
- Extemporaneous (Compound medicines) products are covered only if there is no commercially available product.
Criteria Used by NVHA’s NIHB Program
- Client must hold Citizenship with the Nation.
- Client must hold a Great West Life Benefit number applied for through the NVHA MS&E/Vision Assessor.
- Prescriptions must be prescribed by a licensed doctor or medical specialist.
- Drug must be on Nisga’a Formulary.
How to access Pharmaceutical Program Benefits:
Step 1: Bring your prescription to a pharmacy.
Step 2: Present your GWL Benefit card and the pharmacist will fill your prescription.
Step 3: If your prescription is not on the Nisga’a Formulary, the pharmacy can contact our MS&E/Vision Assessor for information on the special authorization process.
Step 4: Upon additional information requested from your treating physician, your request will be approved or rejected
What are your responsibilities?
The NIHB is the payer of last resort, so please claim under any other health plan before accessing Nisga’a NIHB.
Tell the provider that you are eligible to receive benefits under the Nisga’a NIHB Program, and provide your Great West Life benefits number & your Nisga’a Citizenship Number.
The following products are not covered under this program:
- Evening primrose oil
- Minioxidil topical lotions
- Pentozocan hydrochloride compounds
Special authorization is required for drugs that are not on the Nisga’a Formulary.
Clients are encouraged to apply to Pharmacare when NVHA denies special authorization requests. This is especially encouraged for items that are expensive and/or for long term therapy.
PHARMACARE APPLICATION NUMBER
Call 1-800-387-4977, and ask to be registered with Pharmacare. Pharmacare will ask you for your PHN, and will send you an application in the mail which you must sign and return back to them for review as soon as possible.