Pharmacare Plan W program: Changes for some First Nations Health Authority clients and their physicians

The recent transition of responsibility for First Nations health care in BC from Ottawa to BC First Nations is encouraging, empowering, and a reason to be optimistic. The next step in that transition occurred on 1 October 2017 when in partnership with the BC Ministry of Health, Pharmacare Plan W officially took over providing coverage for eligible prescription drugs, certain medical supplies, and pharmacy services for eligible First Nations Health Authority (FNHA) clients. For First Nations in BC, this transition means the beginning of the end to the federal government’s coverage through Health Canada’s Non-Insured Health Benefits (NIHB) program, which has been provided for generations.

Health outcomes are better when people are fully engaged in their own health journey and health care, and it’s time the ability to make health care decisions came closer to home. By accessing health care benefits from the same provincial systems as other British Columbians, relationships involving Pharmacare, pharmacists, physicians, and nurse practitioners will strengthen, all for the benefit of FNHA clients.

FNHA clients will continue to receive the medications they need. Just a small percentage of clients will have to adjust their drug therapies as they switch to the Pharmacare formulary. Physicians will need to provide information and support to those few who need to change medications as appropriate.

Plan W: What’s the same and what’s different?
FNHA clients will receive 100% coverage of eligible prescription and dispensing fee costs (up to Pharmacare maximums) and certain medical supplies and devices for eligible individuals. Items on the Plan W formulary will be noted as such in the Pharmacare formulary search tool.

There are a few important changes that physicians should discuss with patients. FNHA clients currently taking a medication covered under the Reference Drug program will be given indefinite, full Pharmacare coverage of their current medication. New prescriptions issued after 1 October will be covered under Pharmacare’s reference drug program. If a client is unable to take certain fully covered reference drugs, physicians will be required to apply for special authority (SA) approval for any nonreference drugs to be used.

Clients with existing prescriptions for limited coverage drugs under Pharmacare will also receive automatic SAs for their current medication. Many of these SAs will have an indefinite expiry date as per usual Pharmacare approval periods for coverage.

Some clients with current NIHB coverage for medications that are nonbenefits under Pharmacare may receive automatic, exceptional Pharmacare coverage. Others may require follow-up and review with their treating prescriber.

Clients and health care providers should discuss treatment options as soon as possible to prevent any interruption in coverage.

Out-of-province claims while traveling
Pharmacare is a BC program and cannot directly pay for eligible prescriptions filled in other provinces. Please encourage your patients to plan ahead and fill their prescriptions in BC before traveling out of the province.

If clients choose to fill prescriptions while away, they will have to pay the out-of-pocket cost and apply for reimbursement. Whether or not they will receive full reimbursement depends on whether they pay more than the reimbursement limits set by BC Pharmacare. Drugs covered for all Pharmacare beneficiaries, but not under Plan W, such as smoking cessation therapies, will not be reimbursed for out-of-province purchases.

Registering patients for agency formulary drugs
Patients with conditions such as cancer, HIV, kidney disease, or those who have received a transplant fall within the purview of the excellent specialty health care agencies we have in BC. It is critical that care providers ensure that FNHA clients are enrolled with these agencies so that patients receive their medications directly from the agency without any disruption to their therapies. These agencies include the BC Cancer Agency, BC Centre for Excellence in HIV/AIDS, BC Renal Agency, and BC Transplant Society.

Maintaining client safety
Prescribers should also be aware that as of 1 October the NIHB’s prescription monitoring program is no longer in effect for FNHA clients. This will affect as many as 1200 FNHA clients.

The prescription monitoring program has required clients to have only one prescriber per drug class for specific medications of concern like benzodiazepines, stimulants, gabapentin, and opioids. Without the program, after 1 October patients will not be restricted to a sole prescriber for these medications of concern. Clients may feel empowered without the system restriction, or they may struggle with losing a support system for healthy medication use. There is a potential for risk should patients be allowed to obtain these kinds of medications from multiple physicians or multiple pharmacies.

A prescriber may want to consider putting their patients in Pharmacare’s restricted claimant program if they have concerns about multidoctoring or multipharmacies.

Blood glucose test strips
FNHA clients who currently receive NIHB coverage for blood glucose test strips will be transitioned to Pharmacare coverage for these test strips automatically. Pharmacare limits on blood glucose test strips are actually more generous than NIHB; however, Pharmacare requires new diabetes patients to be instructed on their use at a recognized diabetes education centre. Attending a diabetes education centre will be optional for newly diagnosed FNHA clients until the centre is adequately prepared to ensure consistency of culturally safe practices.

To sum up, everyone will continue to receive the medications they need under BC Pharmacare and the changes outlined above affect a small percentage of clients. The few who do see changes may call our FNHA toll-free number for assistance and should always be encouraged to get advice from their pharmacist, physician, or nurse practitioner.

Updates on the transition will be posted on the FNHA website at www.fnha.ca/pharmacare. Questions from health care providers and patients may be directed to FNHA at 1 855 550-5454 or via e-mail to HealthBenefits@fnha.ca.
—Shannon McDonald, MD
Deputy Chief Medical Officer, CMO Office, First Nations Health Authority