Drugs and pharmacy benefits
Find information about coverage for prescription drugs and over-the-counter products under the Non-Insured Health Benefits (NIHB) Program.
About drugs and pharmacy benefits
The program covers prescription and over-the-counter medications that are:
- included on the NIHB drug benefit list, including benefits that are:
- open, which do not require prior approval
- limited use, which may be eligible for coverage if the criteria for coverage are met
- prescribed by an NIHB recognized health professional, such as a physician
Exception drugs are not listed in the drug benefit list but may be approved in special circumstances.
The program provides eligible clients with coverage for benefits not otherwise available under federal, provincial, territorial or private health insurance.
Drug benefit list
The Drug Benefit List is a listing of the drugs provided as a benefit by the Non-Insured Health Benefits (NIHB) Program. The listed drugs are those primarily used in a home or ambulatory setting.
The purpose of the Drug Benefit List is to:
- Indicate which drug products are eligible benefits; and
- Provide a tool for physicians and pharmacists that encourages the selection of optimal, cost-effective drug therapy.
The Drug Benefit List is generally updated on a quarterly basis.
A prescription from a licensed practitioner is required for any listed drug to be processed as a benefit. Practitioners are those people authorized to prescribe drugs within the scope of practice in their province or territory.
The information contained in this electronic version of the Non-Insured Health Benefits Drug Benefit List requires knowledgeable interpretation and is intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
To receive a print copy, providers must obtain a fax request form from one of the Non-Insured Health Benefits Toll-Free Inquiry Centres.
These updates are now available in Appendix H of the Drug Benefit List.
How to access drugs and pharmacy benefits
You can access the drugs and pharmacy benefits from a licensed pharmacy.
Providers who are enrolled in the program generally send in claims to bill the program directly. This means you do not have to pay a deductible or co-payment. You will need to show client identification in order for providers to bill the program directly.
Express Scripts Canada administers claims for providers on behalf of the program. This website includes:
- a provider agreement
- a claims submission kit