Non-Insured Health Benefits program updates

COVID-19: NIHB services continue

During the coronavirus outbreak, wait times at some call centres and for some services may take longer than usual. Details on temporary changes related to COVID-19, as well as regular program updates, can be found below.

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These updates give First Nations and Inuit clients the latest news on NIHB policies and benefit coverage.

January 2022

Medical supplies and equipment information

Drive Medical Canada recall of bed assist handles and rails

  • Drive Medical Canada has recalled 4 models of home bed assist handles and rails
  • The manufacturer and Health Canada both recommend that clients immediately stop using the recalled devices due to a risk of getting trapped between the bedrails, mattress and bedframe
  • More information on the recall can be found on the Government of Canada's Recalls and safety alerts page
  • Home bed assist handles and rails are affixed alongside a mattress on home-style beds to help people getting into and out of bed. NIHB refers to them as 'bed grab bars'. They are covered as open benefits within Program price and replacement guidelines
  • If you have a bed grab bar, the provider who dispensed it should know the make and model of the device and if it's affected by the recall. Providers are expected to notify affected clients and inform them of next steps
    • if you have not been contacted by your provider and are unsure if your device is affected, contact your provider to find out
  • Providers must take steps to replace the recalled device with one that is safe and effective
  • If you are renting a bed grab bar affected by the recall, your provider should switch it for a similar device that is safe
  • If you are using a recalled bed grab bar that was purchased, it may be eligible for early replacement through NIHB. Your provider should submit a completed prior approval request to the NIHB regional office
  • If you are using a recalled grab bar that is already eligible for replacement, no prior approval is required for a new grab bar that is within NIHB pricing. These devices are covered by NIHB for replacement every ten years

December 2021

Pharmacy benefit information

New pharmacy benefit listings

  • Noromby (enoxaparin sodium) is now available as an open benefit. Prior approval is not required. Noromby is a biosimilar to Lovenox, the reference biologic drug and is used for prevention and treatment of pulmonary embolism and deep vein thrombosis
  • Dupixent (dupilumab) is a now listed as a limited use benefit (prior approval required) for clients 12 years and older with moderate to severe atopic dermatitis. Dupixent was previously listed only for adults
  • Verkazia (cyclosporine 0.1%) is now a limited use benefit for the treatment of severe vernal keratoconjunctivitis (VKC) in children from 4 years of age through adolescence. This condition is an allergic eye disease that primarily affects children
  • Xospata (gilteritinib fumarate) 40 mg is now a limited use benefit for the treatment of adult patients who have relapsed or refractory Acute Myeloid Leukemia (AML)
  • Opsumit (macitentan) 10 mg is a now a limited use benefit for Pulmonary Arterial Hypertension (PAH)
  • Check the NIHB drug benefit list for complete listings and coverage criteria

New coverage for continuous glucose monitoring system for children

  • The continuous glucose monitoring (CGM) system Dexcom G6® is now covered by NIHB as a limited use benefit. Prior approval is required
  • This device is covered for children 2 to 19 years of age on intensive insulin (short-acting insulin 3 or more times per day)

New Suboxone product coverage

  • Suboxone is a medication used to treat opioid dependence
  • In addition to tablets, Suboxone is now available as sublingual film (a small, dissolvable strip that is placed under the tongue)
  • NIHB covers all strengths of this product as a limited use benefit for the treatment of opioid dependence. Prior approval is not required
  • Clients who receive coverage for Suboxone will be enrolled into the NIHB Client Safety Program
  • Check the NIHB drug benefit list for complete listings and coverage criteria for Suboxone products

Medical supplies and equipment information

Licensed practical nurses (LPN) and registered practical nurses (RPN) can now recommend selected benefits

  • NIHB now accepts recommendations from LPNs and RPNs for certain MSE items on the respiratory, self-care, medical surgical, and mobility equipment benefit lists
  • To see which health professionals can prescribe or recommend specific MSE benefits for NIHB coverage, check the MSE guide and benefit lists
    • Items are listed in tables that identify eligible prescribers or recommenders, providers, prior approval requirements and recommended replacement guidelines

Expanded coverage criteria for washable underpads

  • Washable underpads are covered for ostomy care
  • These items require prior approval with a replacement guideline of 6 per year

Augmentative and alternative communication (ACC) listing and name change

  • The iPad speech tablet package is now called the iOS speech tablet package and is listed by NIHB as a limited use benefit. Prior approval is required
  • AAC devices like the iOS speech tablet are used to supplement or replace natural speech when clients have a significant speech impairment
  • Find more information in the communication benefits list

Audiology benefit changes

  • Adhesive wipes are now covered as an open benefit (prior approval not required) for clients with a non-implantable bone conduction hearing system. The replacement guideline is 3 boxes per year
  • Hearing aid accessories are covered as an open benefit. One claim for up to $200, which can include multiple items, is covered every 5 years
  • Check the audiology benefits list for more information

Reminder: hearing aid chargers

  • Rechargeable hearing aids include a charger with the device
  • NIHB will not reimburse for the separate cost of a hearing aid charger, as these are provided by the manufacturer at no additional cost

Vision care benefit information

Reminder: using your eyewear coverage for 2021

  • NIHB covers eye exams and corrective eyewear. The frequency guidelines are:
    • once a year for clients up to 17 years of age
    • every 2 years for clients 18 years or older
  • Frequency is based on the calendar year, which ends on December 31
  • For eyewear, the date of service is the date you picked up the eyewear or the date the provider shipped it to you.
    • for example, for a one-year frequency, if you ordered glasses in 2021 and picked them up by December 31, 2021, you used your coverage for 2021 and will be eligible again in 2022
    • however, if you picked up the glasses in January 2022, you used your coverage for 2022 and won't be eligible again until 2023
  • If you have prior approval for eye glasses or contact lenses that ends on December 31, you are encouraged to pick up your items or have them shipped to you before that date

Low vision aids

General program information

Important reminder: client reimbursement

  • NIHB client reimbursement claims for the following benefits must be submitted to Express Scripts Canada:
    • pharmacy
    • dental
    • medical supplies and equipment
    • vision care
    • mental health counselling benefits
  • Find instructions and forms on the Express Scripts Canada website. The client reimbursement form is located at the bottom of the page
  • Client reimbursement claims for these benefits that are sent to NIHB regional offices will rerouted to Express Scripts Canada, resulting in delayed processing and payment
  • You can submit client reimbursement claims to Express Scripts Canada through your client web account, or by mail or fax
  • The NIHB Program continues to process claims for medical transportation benefits only

October 2021

Positive Airway Pressure (PAP) equipment update

  • NIHB provides coverage of CPAP, BPAP and ventilator devices and supplies listed on the medical supplies and equipment respiratory benefits list
  • Certain Philips Respironics CPAP, BPAP and ventilator devices have been recalled by the manufacturer. More information is available on the Government of Canada Recalls and safety alerts website
  • Clients are required by the manufacturer to follow the registration process on the Philips Respironics website where step-by-step instructions to register a device, including where to find the device serial number are found. Clients can also call the Philips support line at 1-877-907-7508 for help with this process
  • Clients are also encouraged to contact their physician or health care team who can provide advice on whether to continue or discontinue PAP therapy
  • In a July 2021 Program Update, NIHB notified clients of the recall and advised them to contact their provider for assistance with the process for repair and replacement of their device through Philips Respironics
  • For some clients who must continue PAP therapy and cannot safely wait for the repair of their device, NIHB has temporarily implemented a new process and criteria for the replacement or temporary rental of devices affected by the recall
  • Please contact your respiratory benefit provider for more information on eligibility for the replacement or temporary rental of a device
  • NIHB will advise clients should they become aware of additional actions taken by Philip Respironics related to the recall process

September 2021

Pharmacy benefit information

New pharmacy benefit listings

  • Redesca and Inclunox (enoxaparin sodium) are now listed as open benefits with prior approval not required. These medications are used to treat and prevent deep vein thrombosis and pulmonary embolism and are biosimilars to Lovenox
    • When medications are biosimilar, it means that they have been found to work the same way and have similar effectiveness
  • Nubeqa (darolutamide) 300 mg tablets are now listed as a limited use benefit, with prior approval required, for the treatment of prostate cancer
  • Avsola (infliximab) 100 mg/vial injection is now a limited use benefit for treatment of certain types of arthritis and other autoimmune conditions. This medication is a biosimilar to Remicade
  • Check the NIHB drug benefit list for complete listings and coverage criteria

Medications for rare diseases

  • Certain medications for rare diseases that were previously exceptions are now listed by NIHB as limited use benefits
  • The criteria for coverage of these medications has not changed
  • Prior approval for coverage is required
  • The following medications are listed in the NIHB drug benefit list with coverage criteria:
    • Brineura
    • Cystadrops
    • Kanuma
    • Kuvan
    • MDK-Nitisinone
    • Nitisinone
    • Onpattro
    • Orfadin
    • Pheburane
    • Procysbi
    • Radicava
    • Ravicti
    • Revestive
    • Soliris
    • Spinraza
    • Strensiq
    • Tegsedi
    • Vimizim
  • Clients and prescribers should contact the NIHB Drug Exception Centre to ask about medications not included on the NIHB drug benefit list

Listing status change: anticoagulant medications

  • The following anticoagulants (blood thinners), previously listed as limited use benefits, are now open benefits. Prior approval is no longer required for these medications:
    • Eliquis (apixaban) 2.5 mg and 5 mg tablets
    • Lixiana (edoxaban) 15 mg, 30 mg and 60 mg tablets
    • Pradaxa (dabigatran) 110 mg and 150 mg capsules
    • Xarelto (rivaroxaban) 15 mg and 20 mg tablets

Update on coverage of adalimumab

  • Adalimumab is a type of medication used to treat some types of arthritis and other inflammatory conditions. Previously, Humira was the only adalimumab product covered by NIHB
  • NIHB has recently listed additional adalimumab medications that have been approved by Health Canada as biosimilars to Humira
  • Clients with new prescriptions for an adalimumab medication who meet NIHB's coverage criteria will now be covered for the medications listed below, instead of Humira:
    • Amgevita
    • Hadlima
    • Hulio
    • Hyrimoz
    • Idacio
  • Clients who are already taking Humira will continue to be covered for their current medication

Medical supplies and equipment information

Listing status change: adhesive suture strips

  • NIHB now covers adhesive suture strips as an open benefit at $2.40 per strip, up to 50 strips per year
  • Prior approval for these items is no longer required within Program price and frequency guidelines
  • Check the Medical surgical supplies and equipment benefits list for information on these and other wound care benefits

General program information

Reminder: changes to other coverage

  • Please let NIHB know as soon as possible if there are changes to your other health benefit coverage (for example, through an employer sponsored plan)
  • Clients whose other coverage has changed can update their information for one or more benefit areas by contacting Express Scripts Canada's (ESC) NIHB call centre at 1-888-441-4777
  • When updating ESC, clients should specify which benefit areas are affected and the effective date of the change to their coverage status

July 2021

Medical supplies and equipment information

Recall of Philips Respironics Positive Airway Pressure (PAP) Equipment

You are encouraged to contact your physician or health care team who can provide advice on whether to continue or discontinue treatment.

If you are not yet eligible for a new device under NIHB replacement guidelines, your provider can assist you with the process for repair and replacement through Philips Respironics.

The program may consider covering the replacement of your device or providing coverage for a temporary rental device if you are experiencing difficulty with the recall procedures of your equipment. In such situations, please contact your NIHB regional office for assistance.

June 2021

Pharmacy benefit information

New pharmacy benefit listings and changes

  • Trintellix (vortioxetine hydrobromide) is now an open benefit. Prior approval is not required. Trintellix is used in the treatment of major depressive disorder in adults
  • Lonsurf (trifluridine/tipiracil) is now a limited use benefit for treatment of certain cancers. Prior approval is required and coverage criteria can be found in the NIHB drug benefit list
  • The following medications, previously listed as limited use benefits, are now open benefits. Prior approval is no longer required for these medications:
    • Acamprosate (Campral), used for treatment of alcohol use disorder
    • Traditional immunosuppressants – Cyclosporine, Tacrolimus (not including topical), Sirolimus and Mycophenolate
    • Polysaccharide iron complex products – Feramax, Triferexx, Niferex, Polyride-FE, JAMP-Ferrous Polysaccharide

Reminder: Pre-exposure prophylaxis (PrEP) to prevent HIV infection

  • PrEP can prevent HIV infection for individuals who are at high risk of contracting HIV
  • Tenofovir disoproxil fumarate-emtricitabine (Truvada and generics) can be used for PrEP and is covered as an open benefit. Prior approval is not required.

Dental benefit information

Enrolment of independent dental hygienists in Quebec

  • NIHB welcomes independent dental hygienists in Quebec region to enrol with NIHB for direct billing. Quebec legislation now permits dental hygienists to practice independently and bill for dental hygiene services
  • Dental hygienists can enrol with NIHB in all regions except Prince Edward Island and the Territories, where professional regulations do not currently allow dental hygienists to practice independently

General program information

Submitting client reimbursement requests to Express Scripts Canada

  • Express Scripts Canada processes NIHB client reimbursement claims for pharmacy, dental, medical supplies and equipment, vision care and mental health counselling benefits
  • Find instructions and the list of documents required for each benefit type on the NIHB Client Reimbursement website
  • Client reimbursement requests can be submitted to Express Scripts Canada by mail, fax or online through your NIHB client web account
  • If you are submitting a client reimbursement request through your web account:
    • You must attach at least 1 document such as a receipt, prescription, or explanation of benefits from other plans. Clear photos are acceptable
    • Ensure that you have all required documents ready to upload before you submit
    • Once ESC has received and entered the claim for reimbursement, you can view the status in your web account under 'claims history'
    • Claims received and in progress will show as registered. When the claim has been adjudicated, the claim status will show as approved, paid, or rejected
    • You can submit a client reimbursement request for a child under the age of 16 through your web account if you are the parent or guardian, however you will not be able to view the claim status through your account. If the child does not have their own web account, you can contact Express Scripts Canada to check on the status of the claim
  • If you are submitting a client reimbursement request by mail or fax:
    • The NIHB Client Reimbursement form must be completed and all required documents included.
    • Make sure to include your correct address and telephone number, and don't forget to sign and date the form
    • Once the claim has been processed, you will receive a claim statement by mail. You can also view claim status and statements online through your client web account, if you have one
  • Whether you submit your client reimbursement request by mail, fax or through your web account, you can sign up for direct deposit by filling out the NIHB communication preference and direct deposit form, NIHB Client Reimbursement
  • Payment to someone other than the client, such as to a parent or legal guardian for their child's claim, can only be made by cheque
  • If information is missing from your client reimbursement request, you will be contacted by Express Scripts Canada. You may be asked to re-submit the claim
  • If you have any questions about client reimbursement for NIHB pharmacy, dental, medical supplies and equipment, vision care or mental health counselling benefits, please contact Express Scripts Canada
  • Claims for medical transportation benefits are processed by the NIHB Program through Indigenous Services Canada's regional offices.
  • More information on client reimbursement

March 2021

Pharmacy benefit information

New pharmacy benefit listings

  • Emerade (epinephrine bitartrate) is now covered as an open benefit (prior approval not required). Emerade is an adrenaline auto-injector used for the emergency treatment of severe allergic reactions
  • Humira (adalimumab) 20 mg/0.2 mL injection is now covered as a limited use benefit with prior approval, for treatment of:
    • pediatric Crohn's disease
    • polyarticular juvenile idiopathic arthritis in children 2 to 17 years
  • Check the NIHB drug benefit list for listings and coverage criteria

Medical supplies and equipment (MS&E) information

Coverage for walker accessories

Dental benefit information

Expanded coverage for crowns

  • As of April 1, 2021, the NIHB program will expand coverage for crowns on second molars
  • Crowns on second molars will be eligible for coverage whether the first molar is present or not, if all other coverage criteria are met
  • Find the complete crown policy in the NIHB dental benefits guide

Vision care benefit information

Understanding vision care benefit frequency

  • The NIHB program's vision care benefit provides coverage for eligible eye exams and corrective eyewear
  • Under the NIHB vision care policy, the frequency guidelines are:
    • children 0 to 17 years are eligible once a year
    • clients 18 years and older are eligible once every two years
  • Frequency of coverage is calculated by calendar year only, not months and days
    • For example, for a two-year frequency, if you receive coverage for new eyewear at any time in 2019, you will be eligible again starting on January 1, 2021
  • Frequency for eye examinations and eyewear is determined by the last date of service
  • For eye examinations, the date of service is the date you had the exam
  • For services requiring more than one appointment, the date of service is the date when the service was completed
  • For eyewear, such as eyeglasses or contact lenses, the date of service is the date you picked up the eyewear or the date the provider shipped it to you
    • For example, for a one-year frequency, if you ordered glasses in December 2020 and picked them up in December 2020, you used your coverage for 2020. However, if you picked up the glasses in January 2021, you used your coverage for 2021.
  • Clients with specific medical needs may qualify for more coverage, such as reimbursement amount or frequency, on an exception basis. Refer to the NIHB guide to vision care benefits
  • If you need more information on your frequency for vision care benefits, call your NIHB regional office for assistance

Vision care provider billing

  • Many vision care providers are enrolled with NIHB and reimbursed directly by the program for eligible benefits provided to NIHB clients
  • NIHB will reimburse providers up to maximum coverage rates established by the program
  • Before you receive any vision care services, NIHB recommends that you speak with your provider's office to confirm that:
    • the provider is enrolled with NIHB and will bill the program directly
    • the item or service is fully covered by NIHB
    • the provider will not charge you any additional fees
  • If your provider does not bill NIHB directly, you can contact your NIHB regional office for assistance to find an alternate provider

January 2021

Pharmacy benefit information

New coverage for Shingrix

  • As of January 11, 2021, the Shingrix vaccine is covered by NIHB as a limited use benefit
  • Shingrix is a vaccine to prevent shingles, which causes a painful rash and can be severe in some people
  • Shingles is caused by the re-activation of the virus that causes chickenpox. The risk of shingles is higher in seniors and in people with weaker immune systems
  • The vaccine is given in two doses, 2 to 6 months apart
  • Prior approval is not required for clients between 65 and 70 years of age
  • Shingrix is also included on the Formulary for adjunct medications used during active cancer treatment.
  • Clients that have received approval for any medication on this formulary will be automatically approved for Shingrix
  • For clients who have other serious health conditions that weaken their immune system, NIHB will consider coverage on an exception basis
  • If your doctor prescribes the Shingrix vaccine for you, you'll need to get it from the pharmacy. Pharmacists should call the NIHB DEC to request prior approval, if required
  • In most provinces and territories, the Shingrix vaccine can often be administered in pharmacies and pharmacists can bill NIHB for an injection fee. Contact your pharmacy to confirm that they have it in stock and if they can administer the injection
  • If you are unable to have the vaccine administered at a pharmacy, ask your health care provider about other options
  • To maximize the protection offered by Shingrix, it is important that you get both doses. When you get your first dose, ask your doctor or pharmacist to schedule your next dose

Other new pharmacy benefit listings

  • Mezera 1 gram rectal foam (mesalazine) is available as an open benefit, so prior approval is not required. This medication is used for treatment of inflammatory bowel disease
  • Ziextenzo (pegfilgrastim) 10mg/mL injection is listed as an open benefit. This medication is used to prevent infection in clients receiving certain types of cancer treatment
  • Fast-acting dextrose products, Dex-4 Glucose Liquiblast and Dex-4 Glucose Gel are now available as open benefits, in addition to BD Glucose and DEX-4 Glucose tablets. These products are used to quickly raise blood sugar levels for diabetic clients
  • Prevymis (letermovir) vials and tablets are limited use benefits, with prior approval required, for the prevention of cytomegalovirus (CMV) infection in adult clients who have received bone marrow transplants
  • Riximyo (rituximab) 10 mg/mL injection is a limited use benefit for treatment of severe rheumatoid arthritis

Reminder: non-prescription products recommended by pharmacists

  • Under the NIHB pharmacy prescriber policy, pharmacists and other health professionals can recommend non-prescription drugs and health products that are eligible for coverage as NIHB pharmacy benefits and listed on the NIHB drug benefit list
  • Previously, NIHB had a list of selected non-prescription items that could be recommended by a pharmacist. That list is no longer in effect, and is replaced by this new policy
  • This means you don't need a prescription from a doctor for coverage of non-prescription items on the NIHB drug benefit list
  • A few examples of products that can be recommended by pharmacists for NIHB coverage are:
    • smoking cessation products
    • vitamins
    • non-medicated emollient creams, such as Glaxal Base and similar products, for the treatment of eczema. Prior approval is required
  • Check the NIHB drug benefit list to find eligible pharmacy benefits covered by NIHB, as well as any criteria for coverage

Medical supplies and equipment (MS&E) information

Augmentative and alternative communication benefits

  • Augmentative and alternative communication (AAC) benefits are now listed as MS&E benefits
  • These devices and supplies are used to supplement or replace natural speech when clients have a significant speech impairment
  • AAC benefits covered by NIHB include:
    • quick messaging devices
    • speech-generating devices (SGD)
    • communication display boards and software
    • integrated and complex systems
    • software
    • switches and mounting systems
    • accessories
  • Find more information in the communication aids benefits list

Non-implantable bone conduction hearing systems

  • Non-implantable bone conduction hearing systems are now a limited use benefit
  • These products may be used by clients with conductive hearing loss that isn't helped by regular hearing aids
  • Find more information in the audiology benefits list

Reimbursement for gloves

  • NIHB covers latex and vinyl gloves as open benefits, up to 12 boxes per year
  • Providers can bill NIHB, or NIHB will reimburse clients up to $13.75 for one box of 100 gloves in all provinces, and $15.80 in the Territories
  • Gloves are covered with a prescription from a physician or a nurse practitioner, or a written recommendation from a registered nurse
  • Find more information in the medical surgical supplies and equipment benefit list

Vision care benefit information

Temporary coverage of shipping during COVID-19

  • As a temporary measure, vision care providers can bill NIHB for the cost of shipping eligible eyewear to clients who are unable or prefer not to visit the retail location
  • Let your eyewear provider know if you'd like the item shipped to you so they can include the shipping cost in the prior approval request to NIHB

General program information

NIHB clients in British Columbia

  • In BC, the First Nations Health Authority (FNHA) provides health benefit coverage for First Nations people who are BC residents
  • The NIHB program continues to provide coverage and services for Inuit in BC, as well as First Nations who are not BC residents
  • If you are an NIHB client in BC and need help finding a benefit provider, please call NIHB at 1-800-232-7301 for assistance
  • Many providers in BC are enrolled with NIHB to provide benefits and bill the program directly, however they may not see many NIHB clients
  • NIHB recommends that you contact the provider's office before you visit to let them know that you are an NIHB (not FNHA) client, and confirm that they can bill NIHB directly for eligible products and services provided to you
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