NIHB Professional Services

Refusal To Fill Fee

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.

Trial Rx Program

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.

Opioid Dependence Treatment

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.

OPIOID DOSE ESCALATION LIMIT & UPDATE ON COMPENSATION FOR OPIOID TREATMENT

NON-INSURED HEALTH BENEFITS PHARMACY POLICY CHANGE:
OPIOID DOSE ESCALATION LIMIT & UPDATE ON COMPENSATION FOR OPIOID TREATMENT (METHADONE, SUBOXONE AND KADIAN)

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Pharmacist Initiated Treatment

NIHB recently communicated a Pharmacist Initiated Treatment Policy that included a number of conditions and treatments that pharmacists can provide to NIHB patients without prior approval. 

The Pharmacist Initiated Treatment Policy is a national policy, which defers to provincial legislation for scope of practice. This means that pharmacists must adhere to the requirements under the provincial regulations first and foremost , and so, not all sections in this Policy apply in Saskatchewan. Mainly, pharmacist initiated prescription level drug treatments currently are only recognized by NIHB when prescribed by a pharmacist within a Level II Collaborative Practice Agreement or as a Level I Minor Ailment as per the Guidelines and approved drug lists for each condition in Saskatchewan.  

Pharmacists must first consult provincial legislation, and then if the legislation allows, initiate treatment within the list of approved drugs and conditions from the Policy for NIHB patients. For example, provincial legislation currently does not allow a pharmacist to initiate prescription level contraception unless they have a  Level II Collaborative Practice Agreement with that patient’s practitioner, therefore this Policy is not applicable at this time in this particular case. However, in a different scenario, pharmacists can prescribe fluticasone nasal solution for allergic rhinitis for an NIHB patient as per the Level I Minor Ailment Guidelines, because it is a part of the provincial legislation, is a part of the Minor Ailment Guideline formulary and because the drug is on the list of approved drugs on the Pharmacist Initiated Treatment Policy with NIHB.

With respect to initiating treatment, and the requires for non-prescription/OTC versus prescription level treatment options, read below:

Pharmacists may initiate treatment of a non-prescription/OTC level drug to an NIHB patients 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 legisaiton,
  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.

NIHB Pharmacist Initiated Treatment Policy Aid March 2017

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Non-Insured Health Benefits Program Policy Update-January 2017

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