NIHB Professional Services

A pharmacy provider in British Columbia, Saskatchewan, or Manitoba may decide not to fill or refill a prescription when a claim has been rejected through the Drug Utilization Review and it is deemed to be in the best interest of the client. In these cases, a fee equal to the providers usual and customary fee may be charged to the NIHB Program.  The provider is advised to use the 'UL' intervention code on his claim.

In British Columbia and Saskatchewan, the NIHB Program may cover the dispensing fee associated with the provision of a small initial quantity of a 'trial drug' (seven-day supply) that is included under the Trial Prescription Program. To be applicable for reimbursement, the client must not have used the drug in the past two years.

Methadone

• The dispensing fee for methadone will be based upon the following formula (usual and customary dispensing fee*/7) + $5.10 per dose.
• * Up to the Program’s regional maximum.

Suboxone & Kadian

• Usual and customary dispensing fee* per dispense.
• (A separate reimbursement for witnessing the ingestion of Suboxone or Kadian via pseudo DIN 91500002 will no longer be available.)
• * Up to the Program’s regional maximum.

Pharmacists are authorized to prescribe and initiate treatment (non-prescription) of certain medications (found on the BIHB Drug Benefits List) within scope of practice to NIHB patients

Pharmacists must adhere to the requirements under the provincial regulations first and foremost, and so, not all sections may not apply in Saskatchewan.

Pharmacists may initiate treatment of a    non-prescription/OTC  level drug to an NIHB patient if it is:

1. an approved drug in the NIHB Policy,
2. for an approved condition in the NIHB Policy, and
3. documented to include the following information:

a) date;

b) name, and address or date of birth of the patient;

c) proper name, common name, or brand name of the prescribed drug, and the quantity thereof;

d) dosage;

e) amount prescribed or recommended; and

f) signature of the licensed pharmacist.

Pharmacists may initiate treatment of a    prescription   level drug to an NIHB patient if:

1. it is in accordance to provincial legislation,
2. the drug is an approved drug in the NIHB Policy,
3. for an approved condition in the NIHB Policy, and
4. documented according to the requirements of the Patient Assessment Record (PAR) and other provincial legislation, if applicable.

If you have any questions or require further clarification on this Policy, please contact Katherine Windl, Saskatchewan Regional Pharmacist, Non-Insured Health Benefits Directorate with First Nations & Inuit Health Branch at   katherine.windl@canada.ca,    info@skpharmcists.ca  or contact the PAS office at  myla.wollbaum@skpharmacists.ca.