Non-Insured Health Benefits program: Annual report 2024-2025

Introduction

Indigenous Services Canada (ISC)'s Non-Insured Health Benefits (NIHB) program is a national program that provides eligible registered First Nations and recognized Inuit with coverage for a range of medically necessary health benefits when these benefits are not otherwise covered through private or provincial or territorial health insurance plans or social programs.

NIHB program benefits include prescription drugs and select over-the-counter (OTC) medications, dental and vision care, medical supplies and equipment (MS&E), mental health counselling and medical transportation to access medically required health services that are not available on the reserve or in the community of residence. This report covers the 2024-2025 fiscal year. A fiscal year runs from April 1 to March 31. During 2024-2025, NIHB provided access to benefits coverage for 983,461 eligible clients.

Now in its 31st edition, the 2024-2025 NIHB Annual report provides national and regional data on NIHB client population, expenditures, benefit types and benefit utilization. This report is published in accordance with the NIHB program's performance management responsibilities and is intended for the following target audiences:

• First Nations and Inuit organizations and governments at community, regional and national levels
• Regional and headquarters managers and staff of Indigenous Services Canada
• Others in government and in non-government organizations with an interest in the provision of health services to First Nations and Inuit communities

Eligible client population by region March 2025

Ontario had the largest number of eligible clients, at 24.3% of the national total, followed by Manitoba and Saskatchewan with 17.8% each.

Population values are based on region of band registration, which is not necessarily the client's current region of residence. The majority of British Columbia clients previously covered by the NIHB program are now covered by the British Columbia First Nations Health Authority and are not represented in this chart. The remaining NIHB clients in British Columbia are Inuit clients or clients associated with British Columbia bands but residing in other provinces and territories of Canada, where they are covered under the NIHB program.

Source: SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Figure Figure 2.1: Eligible client population by region

This image is a map of Canada with the following population values:

• Atlantic has 72,034
• Quebec has 89,487
• Ontario has 239,025
• Manitoba has 174,827
• Saskatchewan has 175,529
• Alberta has 137,275
• British Columbia has 19,342
• Yukon has 8,004
• Northwest Territories has 28,764
• Nunavut has 39,174
• Total eligible population is 983,461

Eligible population by client type and region March 2024 and March 2025

Of the 983,461 total eligible clients at the end of the 2024-2025 fiscal year, 929,270 (94.5%) were First Nations clients while 54,191 (5.5%) were Inuit clients. The number of First Nations clients increased by 2.6% and the number of Inuit clients increased by 1.8% over the previous year.

From March 2024 to March 2025, British Columbia had the highest percentage change in total eligible clients with a 3.9% increase, followed by Quebec and Saskatchewan with increases of 3.5% and 3.4% respectively.

Eligible client population over time: March 2016 to March 2025

Over the past 10 years, the total number of eligible clients in SVS has increased by 17.2%, from 839,129 in March 2016 to 983,461 in March 2025.

Source: SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 2.1: Eligible client population, March 2016 to March 2025

This image is a bar graph which visually describes NIHB eligible population growth over ten years as follows:

• 2016 was 839,129
• 2017 was 853,088
• 2018 was 867,749
• 2019 was 873,312
• 2020 was 887,518
• 2021 was 898,839
• 2022 was 915,895
• 2023 was 936,006
• 2024 was 959,207
• 2025 was 983,461

Over the past 5 years, the NIHB program's total number of eligible clients increased by 7.9% from 898,839 in March 2021 to 983,461 in March 2025. Quebec had the largest increase in eligible clients over this period, with a growth rate of 17.6%. British Columbia and Saskatchewan followed with growth rates of 13.6% and 10.5% respectively.

Annual population growth, eligible client population and population of Canada 2016 to 2025

Over the previous 10 years, the NIHB eligible client population has grown faster than the population of Canada. From 2016 to 2025, the population of Canada increased by 12.8% while the NIHB eligible First Nations and Inuit client population increased by 16.4%.

Source: SVS and Statistics Canada Catalogue No. 91-002-XWE, Quarterly Demographic Statistics, adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 2.2: Annual population growth, eligible client population and population of Canada.

This image is a line graph that visually describes annual population growth for the NIHB eligible population and for the Canadian population.

Year	2016	2017	2018	2019	2020	2021	2022	2023	2024	2025
NIHB client population	839,129	853,088	867,749	873,312	887,518	898,839	915,895	936,006	959,207	983,461
Growth rate	1.8%	1.7%	1.7%	0.6%	1.6%	1.3%	1.9%	2.2%	2.5%	2.5%
Canadian population	35,832,513	36,264,604	36,708,083	37,058,856	37,618,495	38,028,638	38,239,864	38,935,934	40,083,484	41,288,599
Growth rate	0.8%	1.2%	1.2%	1.0%	1.5%	1.1%	0.6%	1.8%	2.9%	3.0%

Eligible client population by age group, gender and region March 2025

The NIHB program recognizes the importance of representative data for our gender diverse client population. As of 2020, clients can choose Male, Female or Another gender as a gender identifier when applying for or updating their registration with Indigenous Services Canada, which is captured in population and benefit utilization data. Given that the number of individuals choosing Another gender is small, data aggregation to a 2-category gender variable is sometimes necessary to protect the confidentiality of responses provided, in keeping with government practices for safeguarding the privacy of individuals. In these cases, individuals in the category Another gender are randomly distributed into the other 2 gender categories and are denoted by the＋ symbol.

• male＋ includes men and boys as well as some non-binary persons
• female＋ includes women and girls as well as some non-binary persons

Of the 983,461 NIHB eligible clients on the SVS as of March 31, 2025, 49.3% were male, 50.7% were female, and a small percentage of clients were another gender (329).

The average age of the eligible client population was 36 years of age. By region, this average ranged from a low of 29 in Nunavut to a high of 42 in British Columbia.

The average age of the male and female eligible client population was 35 and 37 years, respectively. The average age for males ranged from a low of 29 in Nunavut to a high of 41 in British Columbia. The average age for females varied from a low of 29 in Nunavut to a high of 44 in British Columbia. The average age for clients choosing Another gender was 24 years.

Population analysis by age group March 2025

The overall NIHB client population is relatively young compared to the general population of Canada. The share of the NIHB client population under 20 years of age was 28.1% compared to 20.8% for the population of Canada. Nearly two-thirds (61.0%) of eligible clients are under the age of 40, compared to 49.6% for the population of Canada. The average age of NIHB clients is 36 compared to 40 years of age for the population of Canada.

Source: SVS and Statistics Canada CANSIM table 051-0001, Population by age and sex group, adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 2.3: Proportion of population of Canada and of the NIHB client population by age group

This image is a bar graph that visually describes the proportion of the population of Canada and the NIHB eligible population by age group, as follows:

• the percentage of the population of Canada aged 0 to 9 is 9.8%
• the percentage of the NIHB population aged 0 to 9 is 10.6%
• the percentage of the population of Canada aged 10 to 19 is 11.0%
• the percentage of the NIHB population aged 10 to 19 is 17.6%
• the percentage of the population of Canada aged 20 to 29 is 14.0%
• the percentage of the NIHB population aged 20 to 29 is 16.8%
• the percentage of the population of Canada aged 30 to 39 is 14.8%
• the percentage of the NIHB population aged 30 to 39 is 16.1%
• the percentage of the population of Canada aged 40 to 49 is 12.9%
• the percentage of the NIHB population aged 40 to 49 is 12.1%
• the percentage of the population of Canada aged 50 to 59 is 12.0%
• the percentage of the NIHB population aged 50 to 59 is 10.9%
• the percentage of the population of Canada aged 60 and over is 25.5%
• the percentage of the NIHB population aged 60 and over is 15.9%

Factors influencing NIHB program sustainability 2024-2025

Cost and service pressures on the Canadian health system have been linked to factors such as an aging population and the increased demand for and utilization of health goods, particularly pharmaceuticals and services. In addition to these factors, NIHB program expenditures are driven by the number of eligible clients and their medical needs. A significant proportion of NIHB clients live in small and remote communities and require medical transportation to access health services that are not available locally.

Factors that influence NIHB program sustainability include population, market and professional practice changes including:

• changing demographics, including population growth and registration and an aging population
• health status, including disease burden and prevalence of chronic and infectious diseases
• geographic distribution of client population and accessibility of health services
• advancements in medical research and evidence, treatments and health technologies
• input received from First Nations and Inuit partners
• introduction of newer high-cost therapies and procedures
• changes in health professional fees and scope of practice
• provincial/Territorial health insurance decisions
• shift from insured hospital treatments to non-insured coverage
• economic factors which cause increases in the price of fuel, food and meals and accommodations
• insurance industry dynamics

NIHB expenditures by benefit ($ millions) 2024-2025

In 2024-2025, total NIHB program benefit expenditures were $2,330.7 million. This represents an increase of 11.1% over NIHB expenditures of $2,098.2 million in 2023-2024. Medical transportation costs represented the largest proportion of expenditures at 37.8% ($880.2 million), followed by pharmacy benefit costs at 30.4% ($708.1 million) and dental benefit costs at 18.2% ($425.0 million).

NIHB medical transportation, pharmacy and dental benefit expenditures accounted for 86.4% of all NIHB expenditures in 2024-2025.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 3.1: NIHB expenditures by benefit ($ millions)

This image is a pie chart visually describing NIHB expenditures in millions and proportion of total by benefit area for fiscal year 2024-2025, as follows.

• total expenditure for medical transportation is $880.2 and proportion of total expenditures is 37.8%
• total expenditure for pharmacy is $708.1 and proportion of total expenditures is 30.4%
• total expenditure for dental is $425.0 and proportion of total expenditures is 18.2%
• total expenditure for medical supplies and equipment is $84.0 and proportion of total expenditures is 3.6%
• total expenditure for mental health counselling is $132.6 and proportion of total expenditures is 5.7%
• total expenditure for vision care is $52.4 and proportion of total expenditures is 2.2%
• total expenditure for other is $48.4 and proportion of total expenditures is 2.1%

Approximately $71.8 million in administration costs are not reflected in the $2,330.7 million in NIHB expenditures. More detail is provided in section 11.

NIHB expenditures and growth by benefit 2024-2025

NIHB program benefit expenditures increased by 11.1%, or $232.4 million from fiscal year 2023-2024. The highest net increase in expenditures were in the NIHB medical transportation and pharmacy benefits at $90.6 and $59.5 million, respectively. Factors affecting benefit expenditure growth are discussed in subsequent sections of this report.

Expenditures in the other category include:

• program oversight including costs for claims processing through the Health Information and Claims Processing Services (HICPS) system
• supplementary funding for the BC First Nations Health Authority for additional clients who became eligible after the transfer of responsibilities due to changes in federal legislation
• contribution agreements to support engagement with Indigenous partner organizations
• NIHB navigators

NIHB expenditures by benefit and region (Hundred Thousands of dollars$ 000's) 2024-2025

Manitoba accounted for the highest proportion of total expenditures at $573.1 million, or 24.6% of the national total, followed by Ontario at $454.0 million (19.5%), and Saskatchewan at $447.4 million (19.2%). By comparison, the lowest expenditures were in the Atlantic region at $113.5 million (4.9%).

Headquarters expenditures represent costs paid for claims processing services, as well as operational expenditures associated with NIHB program oversight and policy development. This includes arrangements with the FNHA to provide funding for additional clients who became eligible following the transfer of responsibilities in 2013, due to changes in federal legislation, as well as contribution agreements with Indigenous partner organizations, such as the Assembly of First Nations and Inuit Tapiriit Kanatami, and regional Indigenous organizations. Headquarters expenditures account for 1.4% ($32.3 million) of total NIHB expenditures and do not include the $93.0 million in administration (HQ) costs outlined in section 11.

NIHB annual expenditures ($ Hundred Thousands) and percentage change

In 2024-2025, NIHB program expenditures totalled $2,330.7 million, an increase of 11.1% from $2,098.2 million in 2023-2024. Since 2015-2016, total expenditures have grown by 111.8%. The annualized rate of growth over this period was 8.5%. There has been wide variation in growth rates between 2015-2016 and 2024-2025, from a low of -1.9% in 2020-2021 to a high of 13.7% in 2021-2022.

Fluctuations in NIHB expenditures growth rates are impacted by a number of factors. Changes in the eligible client population have a direct impact on growth, including an increase in eligible clients as a result of amendments to the Indian Act. The coronavirus (COVID-19) outbreak and provincial and territorial public health restrictions on the provision of in-person services in fiscal year 2020-2021, along with larger than typical utilization of NIHB benefits in fiscal 2021-2022 once restrictions were ended, impacted growth in those years.

Source: FIRMS and FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 3.2: NIHB annual expenditures ($ hundred thousands) and percentage change

This image is a bar graph which visually describes NIHB annual expenditures in millions and annual percentage change by fiscal year, as follows:

• 2015 to 2016 is $1,101 and 6.7%
• 2016 to 2017 is $1,207 and 9.7%
• 2017 to 2018 is $1,309 and 8.4%
• 2018 to 2019 is $1,391 and 6.2%
• 2019 to 2020 is $1,519 and 9.3%
• 2020 to 2021 is $1,491 and -1.9%
• 2021 to 2022 is $1,695 and 13.7%
• 2022 to 2023 is $1,892 and 11.6%
• 2023 to 2024 is $2,098 and 10.9%
• 2024 to 2025 is $2,330 and 11.1%

NIHB annual expenditures by benefit (Hundred thousands of dollars$ 000's)

In the 10-year period ending 2024-2025, expenditures for NIHB mental health services grew faster than other benefit areas. Mental health expenditures counselling had the highest percentage growth at 718.8%, from $16.2 million in 2015-2016 to $132.6 million in 2024-2025. Medical transportation had the biggest increase in expenditures from $375.9 million in 2015-2016 to $880.2 million in 2024-2025, a change of 134.2%.

Over the same period, medical supplies and equipment (MS&E) expenditures increased by 174.0% and dental expenditures increased by 98.4%.

Per capita NIHB expenditures by region 2024-2025

Expenditures per capita are total NIHB expenditures divided by the number of eligible clients, regardless of whether clients submitted a claim in the reporting period.

National per capita expenditures for all benefits in 2024-2025 were $2,337. Manitoba had the highest per capita cost at $3,279. The Northern region followed with a per capita cost of $3,030. The higher than average per capita cost for these regions is partly attributable to high medical transportation costs due to the large number of First Nations and Inuit clients living in remote or fly-in only northern communities. By contrast, the Atlantic region had the lowest per capita cost of $1,575, due to the comparatively low medical transportation expenditures in the region.

Source: FST and SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 3.3: Per capita NIHB expenditures by region

This bar graph visually describes NIHB annual expenditures in millions by fiscal year and by region. Per capita expenditures:

• for Atlantic are $1,575
• for Quebec are $1,719
• for Ontario are $1,899
• for Manitoba are $3,279
• for Saskatchewan are $2,549
• for Alberta are $2,307
• for the North are $3,030
• national per capita expenditures are $2,337

Distribution of NIHB pharmacy expenditures ($ Hundred thousands) 2024-2025

The NIHB pharmacy benefit has multiple parts. Prescription drugs paid through the Health Information and Claims Processing Services (HICPS) system was the largest piece, accounting for $554.5 million or 78.3% of all NIHB pharmacy expenditures, followed by over-the-counter (OTC) and controlled access (CAD) drugs (HICPS) which totalled $137.4 million or 19.4%.

Pharmacy benefit expenditures outside of HICPS, at $2.1 million or 0.3% of pharmacy benefit costs, refers to prescription drugs and OTC medications paid through Indigenous Services Canada regional offices.

Contribution agreements, which accounted for $14.2 million or 2.0% of total pharmacy benefit costs, are used to fund pharmacy benefits through agreements such as those with the Mohawk Council of Akwesasne in Ontario and the Bigstone Cree Nation in Alberta.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 4.1: Distribution of NIHB pharmacy expenditures ($ Hundred thousands)

This image is a pie chart which visually describes NIHB pharmacy expenditures in millions and proportion of total expenditures by component type:

• HICPS pharmacy expenditures are $691.8 million and 97.7%
• contribution agreements are $14.2 million and 2.0%
• Non-HICPS benefits expenditures are $2.1 million and 0.3%
• total expenditures $708.1

Total NIHB pharmacy expenditures by type and region (Hundred thousands of dollars$ 000's) 2024-2025

Prescription drug costs paid through the HICPS system represented the largest component of total NIHB Pharmacy costs accounting for $554.5 million. Saskatchewan had the largest proportion of these costs at 20.6%, followed by Manitoba at 19.9% and Ontario at 18.7%.

The next highest component was over-the-counter (OTC) and controlled access drug (CAD) costs at $137.4 million or 19.4%. Saskatchewan (23.6%), Manitoba (21.9%) and Alberta (16.1%) had the largest proportions of these costs in 2024-2025.

Annual NIHB pharmacy expenditures

NIHB pharmacy expenditures increased by 9.2% during fiscal year 2024-2025. Over the past 5 years, growth in pharmacy expenditures ranged from a high of 9.2% this year to a low of 5.1% in 2020-2021.

The 5 year annualized growth rate for NIHB pharmacy expenditures is 6.8%. The introduction of lower cost generic drugs as they become available on the market has kept pharmacy benefit growth moderate. As well, NIHB has negotiated Product Listing Agreements (PLA) with drug manufacturers to allow for the coverage of certain medications at a reduced price through the use of rebates. On March 31, 2025, NIHB had over 350 PLA in effect.

Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 4.2: Annual NIHB pharmacy expenditures and percentage change

This image is a bar graph which visually describes NIHB annual pharmacy expenditures in millions and percentage change by fiscal year, as follows:

• 2020 to 2021 expenditures are $536.7 million and growth is 5.1%
• 2021 to 2022 expenditures are $566.1 million and growth is 5.5%
• 2022 to 2023 expenditures are $605.8 million and growth is 7.0%
• 2023 to 2024 expenditures are $648.6 million and growth is 7.1%
• 2024 to 2025 expenditures are $708.1 million and growth is 9.2%

NIHB pharmacy utilization rates by region

Utilization rates represent the number of clients who received at least 1 pharmacy benefit paid through the HICPS system in the fiscal year, as a proportion of the total number of eligible clients.

In 2024-2025, the national utilization rate was 63% for NIHB pharmacy benefits paid through the HICPS system. The rate understates the actual level of utilization as the data do not include pharmacy services provided through contribution agreements and benefits provided through community health facilities or regional offices.

Clients of the Bigstone Cree Nation in Alberta and Akwesasne in Ontario are not included in this calculation as those clients receive pharmacy benefits through a contribution agreement and not through HICPS.

NIHB pharmacy claimants by age group and gender 2024-2025

Of the 983,461 clients eligible to receive benefits under the NIHB program, a total of 601,045 claimants received at least 1 pharmacy item paid through the Health Information and Claims Processing Services (HICPS) system in 2024 to 2025. Of this total, 339,448 were female (56.5%) and 261,597 were male (43.5%). This compares to the total eligible population where 50.7% were female and 49.3% were male.

The average age of pharmacy claimants was 38. The average age for female and male claimants was 38 and 37, respectively.

Pharmacy benefit utilization varies by age. In 2024 to 2025, 3.7% of all clients were in the 0 to 4 age group, but this group accounted for only 0.5% of all pharmacy claims made and only 0.7% of total pharmacy expenditures. In contrast, 10.9% of all eligible clients were in the 65+ age group, but accounted for 25.9% of all pharmacy claims submitted and 17.7% of total pharmacy expenditures.

Source: HICPS, FST and SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 4.3: Distribution of eligible NIHB population, pharmacy expenditures and pharmacy incidence by age group

This image is a bar graph which visually describes percentage of NIHB annual pharmacy expenditures and incidence by age group, as follows:

Age	Eligible clients	Expenditures	Incidence
0 to 4	3.7%	0.7%	0.5%
5 to 9	6.8%	1.6%	1.0%
10 to 14	8.4%	2.0%	1.3%
15 to 19	9.2%	3.1%	2.1%
20 to 24	8.4%	3.9%	2.8%
25 to 29	8.4%	6.1%	4.6%
30 to 34	8.6%	8.3%	7.1%
35 to 39	7.5%	8.8%	7.9%
40 to 44	6.4%	8.9%	8.3%
45 to 49	5.7%	8.7%	8.3%
50 to 54	5.5%	9.6%	9.4%
55 to 59	5.4%	10.3%	10.4%
60 to 64	5.0%	10.2%	10.7%
65 plus	10.9%	17.7%	25.9%
Total	100.0%	100.0%	100.0%

During 2024-2025, the average claimant aged 65 or more submitted 92 claims compared to 73 claims for their counterpart in the 60 to 64 age group and 6 claims for the average claimant in the 0 to 9 age group.

Pharmacy benefit cost per NIHB claimant expenditures vary according to age. For example, in 2024-2025 the average cost per child aged 0 to 4 years was $285. The cost increased steadily for every age group, with claimants aged 30 to 34 having an average cost of $1,113, comparable to the total average claimant cost of $1,178. Claimants aged 60 to 64 years had the highest cost per claimant with an average of $2,027 for all pharmacy claims received throughout the fiscal year.

NIHB Top ten therapeutic classes by number of claimants 2024-2025

Table 4.5 ranks the top 10 therapeutic classes of prescription drugs according to number of claimants. In 2024-2025, Penicillins had the highest number of distinct claimants, at 181,721. Antidepressants ranked second in number of claimants, with 132,336 followed by Proton Pump Inhibitors with 120,214 claimants.

NIHB over-the-counter, including CAD drug claims incidence by therapeutic class 2024-2025

Table 4.6 looks at the number of claims by therapeutic classification for over-the-counter (OTC) drugs.

Vitamins accounted for the largest number of OTC drug claims in 2024-2025 at 1.6 million paid claims or 28.3% of all OTC claims. Central nervous systems agents had the next highest share of OTC claims at 1.1 million (19.9%) followed by electrolytic, caloric and water balance drugs at 481,632 claims (8.8%).

Distribution of NIHB MS&E expenditures ($ Hundred thousands) 2024-2025

The NIHB MS&E benefit has multiple components. The cost of medical equipment paid through the HICPS system was the largest component, accounting for $58.3 million or 69.4% of all NIHB MS&E expenditures, followed by medical supplies paid through HICPS which totalled $23.9 million or 28.4%.

Contribution agreements, which accounted for $0.8 million or 1.0% of total MS&E benefit costs, are used to fund benefits through agreements such as those with the Mohawk Council of Akwesasne in Ontario and the Bigstone Cree Nation in Alberta.

MS&E benefit costs outside of HICPS, which refers to MS&E items paid through Indigenous Services Canada regional offices, accounted for $1.0 million or 1.2%.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 5.1: Distribution of NIHB MS&E expenditures ($ Millions)

This image is a pie chart which visually describes NIHB medical supplies and equipment expenditures in millions and proportion of total expenditures by component type:

• HICPS MS&E are $82.2 and 97.8%
• contribution agreements are $0.8 and 1.0%
• MS&E benefit costs outside of HICPS are $1.0 and 1.2%
• total expenditures $84.0

Total NIHB MS&E expenditures by type and region (Hundred Thousands$ 000's) 2024-2025

Medical equipment costs paid through the HICPS system represented the largest component of total NIHB MS&E expenditures at $58.3 million. Saskatchewan had the largest proportion of these costs at 24.2%, followed by Manitoba at 22.0% and Alberta at 17.3%.

The next highest component was medical supplies costs at $23.9 million. Saskatchewan (28.0%), Ontario (17.8%) and Manitoba (17.0%) had the largest proportions of these costs in 2024 to 2025.

All other MS&E expenditures, including contribution agreement costs, account for only 2.0% of total MS&E expenditure.

Annual NIHB MS&E expenditures

NIHB MS&E expenditures increased by 11.8% during fiscal year 2024-2025. Over the past 5 years, growth in MS&E expenditures has ranged from a high of 17.9% in 2021-2022 to a low of -4.3% in 2020-2021.

The 5 year annualized growth rate for NIHB MS&E expenditures is 9.6%.

Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 5.2: Annual NIHB MS&E expenditures

This is a bar graph which visually describes NIHB annual pharmacy expenditures in millions and percentage change by fiscal year, as follows:

This is a bar graph which visually describes NIHB annual pharmacy expenditures in millions and percentage change by fiscal year, as follows:

• 2020 to 2021 is $50.9 and -4.3%
• 2021 to 2022 is $60.1 and 17.9%
• 2022 to 2023 is $65.2 and 8.3%
• 2023 to 2024 is $75.1 and 15.3%
• 2024 to 2025 is $84.0 and 11.8%

NIHB MS&E utilization rates by region

Utilization rates are the number of clients who received at least 1 MS&E benefit paid through the HICPS system in the fiscal year, as a proportion of the total number of eligible clients.

In 2024-2025, the national utilization rate for NIHB MS&E benefits paid through the HICPS system was 9%. The rate understates the actual level of utilization as the data do not include MS&E services provided through contribution agreements and benefits provided through community health facilities.

Clients of the Bigstone Cree Nation in Alberta and Akwesasne in Ontario are not included in this calculation as those clients receive MS&E benefits through a contribution agreement and not HICPS.

NIHB MS&E claimants by age group and gender 2024-2025

Of the 983,461 clients eligible to receive benefits under the NIHB program, a total of 86,247 claimants, representing 9% of the NIHB client population, received at least 1 MS&E item paid through the Health Information and Claims Processing Services (HICPS) system in 2024-2025. Of this total, 49,594 were female (57.5%) and 36,653 were male (42.5%). This compares to the total eligible population where 51% were female and 49% were male.

The average age of MS&E claimants was 50. The average age for female and male claimants was 51 and 49, respectively.

Source: HICPS, FST and SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 5.3: Distribution of eligible NIHB population, MS&E expenditures and MS&E incidence by age group

This image is a bar graph which visually describes NIHB annual MS&E expenditures and incidence by age group, as follows:

Age	Eligible Clients	Expenditures	Incidence
0 to 4	3.7%	2.2%	1.5%
5 to 9	6.8%	3.8%	3.2%
10 to 14	8.4%	3.2%	2.7%
15 to 19	9.2%	2.8%	2.6%
20 to 24	8.4%	2.3%	2.7%
25 to 29	8.4%	2.8%	3.4%
30 to 34	8.6%	3.6%	4.5%
35 to 39	7.5%	4.3%	5.2%
40 to 44	6.4%	4.9%	5.2%
45 to 49	5.7%	5.3%	6.0%
50 to 54	5.5%	7.5%	7.6%
55 to 59	5.4%	9.4%	9.6%
60 to 64	5.0%	11.2%	10.7%
65 plus	10.9%	36.7%	35.2%
Total	100.0%	100.0%	100.0%

MS&E benefit utilization varies by age. In 2024-2025, 3.7% of all clients were in the 0 to 4 age group, but this group accounted for only 1.5% of all MS&E claims made and only 2.2% of total MS&E expenditures. In contrast, 10.9% of all eligible clients were in the 65+ age group, but they accounted for 35.2% of all MS&E claims submitted and 36.7% of total MS&E expenditures.

The average MS&E claimant submitted 5 claims in 2024-2025, a rate that is relatively consistent over all age groups.

NIHB medical supplies expenditures by category 2024-2025

In 2024-2025, medical surgical supplies such as incontinence items accounted for 80.3% of all medical supply expenditures, an increase from the 78.5% recorded in 2023-2024. Self-care supplies, such as enteral feeding bags, represented 6.3% of all medical supply expenditures, followed by prosthetic supplies, such as prosthetic liners at 4.1%.

Source: HICPS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 5.4: NIHB medical supplies expenditures by category

This bar graph visually describes percentage of NIHB medical equipment expenditures by category, as follows:

• medical surgical supplies is 80.3%
• self-care supplies is 6.3%
• prosthetic supplies is 4.1%
• audiology supplies is 3.2%
• oxygen supplies is 2.2%
• respiratory supplies is 2.0%
• all others is 1.8%

NIHB medical equipment expenditures by category 2024-2025

In 2024-2025, mobility equipment such as wheelchairs accounted for 19.0% of all medical equipment expenditures, a decrease from the 21.7% recorded in 2023-2024. Audiology equipment, such as hearing aids, represented 18.3% of all medical equipment expenditures, followed by respiratory equipment such as CPAP machines at 11.8%.

Source: HICPS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 5.5: NIHB medical supplies expenditures by category

This bar graph visually describes percentage of NIHB medical equipment expenditures by category, as follows:

• mobility equipment is 19.0%
• audiology equipment is 18.3%
• self-care equipment is 11.8%
• respiratory equipment is 9.6%
• oxygen equipment is 7.7%
• orthotics equipment is 7.0%
• all others is 14.7%

Distribution of NIHB dental expenditures ($ millions) 2024-2025

NIHB dental expenditures include multiple components. Dental costs paid through the HICPS system represented the largest expenditure portion, accounting for $399.2 million or 93.3% of all NIHB dental costs.

The next highest component was contribution agreements, which accounted for $16.1 million or 3.8% of total dental expenditures. Contribution agreements are used to fund dental benefits through agreements such as those with the Mohawk Council of Akwesasne in Ontario and the Bigstone Cree Nation in Alberta.

Dental benefit expenditures outside of HICPS, which are comprised mostly of contract dentists providing services to clients in remote communities, totalled $9.7 million or 2.3% of total costs.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 6.1: Distribution of NIHB dental expenditures ($ millions)

This image is a pie chart which visually describes NIHB dental expenditures in millions by component type.

• HICPS dental expenditures are $399.2 and 93.9%
• Dental benefit costs outside of HICPS are $9.7 and 2.3%
• contribution agreements are $16.1 and 3.8%
• total dental expenditures are $425.0

Total NIHB dental expenditures by type and region (Hundred Thousands of dollars$ 000's) 2024-2025

Of the $425.0 million in NIHB dental expenditures in 2024-2025, Saskatchewan (20.5%), Alberta (19.5%) and Ontario (19.4%) had the largest overall proportion. Saskatchewan had the highest total dental expenditures at $87.0 million and the Atlantic region had the lowest total dental expenditures at $16.0 million.

Annual NIHB dental expenditures

NIHB dental expenditures increased by 11.9% during fiscal year 2024-2025. Over the last 5 years, annual growth rates for NIHB dental expenditures have ranged from a high of 28.2% in 2021-2022 to a low of -16.0% in 2020-2021.

The coronavirus (COVID-19) outbreak and provincial and territorial public health restrictions on the provision of in-person services in fiscal year 2020 to 2021, along with larger than typical utilization of the benefit in fiscal 2021-2022 once restrictions were ended, significantly impacted growth in those 2 years.

The 5 year annualized growth rate for NIHB dental expenditures is 8.9%.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 6.2: NIHB dental expenditures and annual percentage change

This image is a bar graph which visually describes NIHB dental expenditures in millions and annual percentage change by fiscal year, as follows:

• 2020 to 2021 is $233.2 and -16.0%
• 2021 to 2022 is $299.1 and 28.2%
• 2022 to 2023 is $329.1 and 10.0%
• 2023 to 2024 is $379.9 and 15.4%
• 2024 to 2025 is $425.0 and 11.9%

NIHB dental expenditures by region

NIHB dental utilization rates by region

Utilization rates reflect the number of clients who, during the fiscal year, received at least 1 dental service paid through the HICPS system as a proportion of the total number of eligible clients.

In 2024-2025, the national utilization rate for dental benefits paid through the HICPS system was 37%. NIHB dental utilization rates in 2020-2021 were impacted by provincial and territorial public health restrictions on the provision of in-person services due to the coronavirus (COVID-19) outbreak.

The rates understate the actual level of utilization as the data do not include dental services provided through community health facilities or other Indigenous Services Canada programs such as Community Oral Health Services which include dental therapy services and the Children's Oral Health Initiative (COHI). Clients of the Bigstone Cree Nation in Alberta and Akwesasne in Ontario are not included in this calculation as those clients receive dental benefits through a contribution agreement and not through HICPS.

Over the 2 year period between 2023-2024 and 2024-2025, 477,993 distinct clients received NIHB dental services through HICPS, resulting in an overall 50% utilization rate over this time.

NIHB dental claimants by age group, gender and region 2024-2025

Of the 983,461 clients eligible to receive dental benefits through the NIHB program, 359,138 claimants (37%) received at least 1 dental procedure paid through the HICPS system in 2024-2025.

Of this total, 201,591 were female (56%) and 157,547 were male (44%), compared to the total eligible NIHB population where 51% were female and 49% were male.

The average age of dental claimants was 34, indicating clients tend to access dental services at a slightly younger age compared to pharmacy services at 38 years of age. The average age for female and male claimants was 35 and 32 years of age, respectively.

Source: HICPS and SVS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 6.3: Distribution of eligible NIHB population, dental expenditures and incidence by age group

This image is a bar graph which visually describes distribution percentage of NIHB dental clients, incidence and expenditures by age group, as follows:

Age	Eligible clients	Expenditures	Incidence
0 to 4	3.7%	3.7%	3.7%
5 to 9	6.8%	6.9%	9.4%
10 to14	8.4%	8.9%	11.2%
15 to 19	9.2%	12.3%	11.6%
20 to 24	8.4%	9.6%	8.7%
25 to 29	8.4%	8.7%	8.3%
30 to 34	8.6%	8.5%	8.2%
35 to 39	7.5%	7.4%	7.0%
40 to 44	6.4%	6.0%	5.8%
45 to 49	5.7%	5.3%	5.1%
50 to 54	5.5%	5.1%	4.9%
55 to 59	5.4%	5.2%	4.9%
60 to 64	5.0%	4.6%	4.3%
65 plus	10.9%	7.7%	6.9%
	100.0%	100.0%	100.0%

Approximately 32% of all dental claimants were under the age of 20. 36% of male claimants were in this age group compared to 30% of female claimants. Approximately 9% of all claimants were seniors aged 65 and over in 2024-2025.

NIHB fee-for-service dental expenditures by service category 2024-2025

In 2024-2025, expenditures for restorative services, for example, crowns, fillings, etc. were the highest of all dental service categories at $179.6 million. Diagnostic services, such as examinations, radiographs, etc. at $47.2 million and preventive services, for example, scaling, sealants, etc. at $45.0 million were the next highest service categories. Rounding out the top 5 were oral surgery, including extractions, etc. at $41.7 million and endodontic services, such as root canal treatments, etc. at $30.9 million.

In 2024-2025, the 3 highest dental procedures by expenditure were composite restorations ($152.4 million), scaling ($30.8 million) and extractions ($30.2 million).

Distribution of NIHB medical transportation expenditures ($ millions) 2024-2025

In 2024-2025, NIHB medical transportation expenditures totalled $880.2 million.

Contribution agreements for the management of medical transportation benefits by First Nations communities, territorial governments and other organizations represented the largest component, accounting for $342.4 million, or 38.9% of total benefit expenditures.

Of benefit expenditures managed by the NIHB program, accommodations and meals at $150.2 million (17.1%), scheduled flights at $135.9 million (15.4%) and air ambulance at $123.4 million (14.0%) were the largest expenditures, accounting for a combined total of over 45%.

Rounding out medical transportation expenditures are costs for land ambulance at $69.5 million (7.9%), land and water transportation at $39.8 million (4.5%) and chartered flights at $19.0 million (2.2%).

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 7.1: Distribution of NIHB medical transportation expenditures ($ millions)

This image is a pie chart which visually describes NIHB medical transportation expenditures and percentage by type, as follows:

• expenditures for scheduled flights are $135.9 million and 15.4%
• accommodations and meals are $150.2 million and 17.1%
• air ambulances are $123.4 million and 14.0%
• land ambulances are $69.5 million and 7.9%
• land and water transportation are $39.8 million and 4.5%
• chartered flights are $19.0 million and 2.2%
• contribution agreements are $342.4 million and 38.9%
• total of $880.2 million

Annual NIHB medical transportation expenditures

NIHB medical transportation expenditures increased by 11.5% in 2024-2025 compared to the previous year. Over the past 5 years, overall medical transportation costs have grown by 67.4% from $525.7 million in 2020-2021 to $880.2 million in 2024-2025.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 7.2: Annual NIHB medical transportation expenditures

This image is a bar graph which visually describes NIHB medical transportation expenditures and percentage growth by year, as follows:

• 2020 to 2021 are $525.7 and -2.1%
• 2021 to 2022 are $602.2 and 14.6%
• 2022 to 2023 are $710.6 and 18.0%
• 2023 to 2024 are $789.6 and 11.1%
• 2024 to 2025 are $880.2 and 11.5%

On a regional basis, the highest 5 year growth rate was in Ontario where expenditures grew by 104.6% from $90.6 million in 2020-2021 to $185.5 million in 2024-2025. This was followed by Manitoba with an increase of 95.3% from $155.8 million in 2020-2021 to $304.3 million in 2024-2025.

NIHB medical transportation expenditures by type and region (Hundred Thousands of dollars$ 000's) 2024-2025

In 2024-2025 Manitoba had the highest overall NIHB medical transportation expenditures at $304.3 million, primarily as a result of air transportation, which totalled $180.4 million. High medical transportation costs in the region reflect in part the large number of First Nations clients living in remote or fly-in only northern communities.

Ontario had the second highest medical transportation expenditures total in 2024-2025 at $185.5 million. Saskatchewan followed at $137.6 million.

Distribution of NIHB vision care expenditures ($ millions) 2024-2025

NIHB vision care expenditures are comprised of several distinct components. Fee-for-service vision care costs paid through HICPS system represented the largest expenditure portion, accounting for $47.7 million or 91.2% of all NIHB vision care costs.

The next highest component was contribution agreements, which accounted for $4.6 million or 8.7% of total vision care costs. Contribution agreements are used to fund First Nations or Inuit communities and organizations or territorial governments directly for the provision of vision care benefits.

Regional vision care, at $39,200 or 0.1% of vision care benefit costs, refers to vision care claims paid through Indigenous Services Canada regional offices.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 8.1: Distribution of NIHB vision care expenditures ($ millions)

This image is a pie chart which visually describes NIHB vision care expenditures and proportion of total expenditure by component type as follows:

• vision care (HICPS) at $47.7 million and 91.2%%
• vision care (regional) at $39 thousand and 0.1%
• contribution agreements at $4.6 million and 8.7%
• total of $52.4 million

NIHB vision care expenditures and growth by region (Hundred Thousands of dollars$ 000's) 2024-2025

NIHB vision care expenditures totalled $52.4 million in 2024-2025, an increase of 0.6% from the previous year.

Saskatchewan had the highest vision care costs at $12.0 million or 23.1% of total vision care expenditure, followed by Ontario at $9.8 million (18.7%) and Alberta at $9.2 million (17.5%).

Annual NIHB vision care expenditures and percentage change

NIHB vision care expenditures increased by 0.6% during fiscal year 2024-2025. Over the past 5 years, growth in vision care expenditures has ranged from a high of 20.9% in 2021-2022 to a low of -14.4% in 2020-2021.

The 5 year annualized growth rate for NIHB vision care expenditures is 2.6%.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 8.2: Annual NIHB vision care expenditures (Hundred Thousands of dollars)

This image is a bar graph which visually describes NIHB vision care expenditures by year in millions and percentage change, as follows:

• 2020 to 2021 is $39.4 million and -14.4%
• 2021 to 2022 is $47.6 million and 20.9%
• 2022 to 2023 is $49.2 million and 3.4%
• 2023 to 2024 is $52.0 million and 5.7%
• 2024 to 2025 is $52.4 million and 0.6%

On a regional basis, the highest growth rate over this 5 year period was in the North where expenditures grew by 58.1% from $3.2 million in 2020-2021 to $5.0 million in 2024-2025. Saskatchewan had largest net increase in expenditures over this period, where costs grew by $3.6 million.

NIHB vision care claimants by age group, gender and region 2024-2025

Of the 983,461 clients eligible to receive benefits under the NIHB program, a total of 178,094 claimants, representing 18.1% of the NIHB client population, had at least 1 vision care claim paid through the Health Information and Claims Processing Services (HICPS) system in 2024-2025. Of this total, 107,261 were female (60.2%) and 70,833 were male (39.8%). This compares to the total eligible population where 51% were female and 49% were male.

The average age of vision care claimants was 37 years of age. The average age for female and male claimants was 37 and 36 years, respectively.

NIHB vision care utilization rates by region

Utilization rates reflect the number of clients who, during the fiscal year, received at least 1 vision care service paid through the HICPS system as a proportion of the total number of eligible clients.

In 2024-2025, the national utilization rate for vision care benefits paid through the HICPS system was 18%. NIHB vision care utilization rates for 2020-2021 are artificially low as the data for that year are incomplete.

The rates understate the actual level of utilization as the data do not include vision care services provided through contribution agreements and benefits provided through community health facilities or other Indigenous Services Canada.

Over the 2 year period between April 1, 2023 and March 31, 2025, 304,784 distinct clients received NIHB vision care services through HICPS, resulting in an overall 31% utilization rate over this time.

NIHB vision care expenditures by category 2024-2025

In 2024-2025, new eyewear, such as eyeglasses, accounted for $42.1 million or 85.9% of all HICPS vision care expenditures. Eye exams were $6.3 million or 12.9%, followed by repairs at $258 thousand or 0.5%.

Distribution of NIHB mental health counselling expenditures ($ millions) 2024-2025

NIHB mental health counselling expenditures are comprised of several distinct components. Fee-for-service mental health counselling costs paid through HICPS system represented the largest expenditure portion, accounting for $84.6 million or 63.8% of all NIHB mental health counselling costs.

The next highest component was contribution agreements, which accounted for $29.7 million or 22.4% of total mental health counselling costs. Contribution agreements are used to fund First Nations or Inuit communities and organizations or territorial governments directly for the provision of mental health counselling benefits.

Regional mental health counselling, at $18.3 million or 13.8% of mental health counselling benefit costs, refers to mental health counselling claims paid through Indigenous Services Canada regional offices.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 9.1: Distribution of NIHB mental health counselling expenditures ($ millions)

This image is a pie chart which visually describes NIHB mental health counselling expenditures in millions and proportion of total expenditures by component type as follows:

• mental health counselling (HICPS) at $84.6 and 63.8%
• mental health counselling outside of HICPS at $18.3 and 13.8%
• contribution agreements at $29.7 and 22.4%

NIHB mental health counselling expenditures by region (Hundred Thousands of dollars$ 000's) 2024-2025

NIHB mental health counselling expenditures totalled $132.6 million in 2024-2025, an increase of 12.9% from the previous year.

Saskatchewan had the highest mental health counselling costs at $35.3 million, or 26.6% of total mental health counselling expenditures, followed by Ontario at $31.2 million (23.5%) and Manitoba at $23.5 million (17.8%).

NIHB mental health counselling expenditures and annual percentage change

NIHB mental health counselling expenditures increased by 12.5% during fiscal year 2024-2025. Over the past 5 years, mental health counselling costs have grown by 80.8% from $73.3 million in 2020-2021 to $132.6 million in 2024-2025. Over the past 5 years, growth in mental health counselling expenditures has ranged from a high of 33.0% in 2020-2021 to a low of 5.2% in 2022-2023.

The 5 year annualized growth rate for NIHB mental health counselling expenditures is 19.2%.

Source: FST adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 9.2: NIHB mental health counselling expenditures and annual percentage change

This image visually describes NIHB mental health counselling expenditures and annual percentage change by year, as follows:

• 2020 to 2021 is $73.7 million and 33.0%
• 2021 to 2022 is $93.7 million and 27.8%
• 2022 to 2023 is $98.6 million and 5.2%
• 2023 to 2024 is $117.4 million and 19.1%
• 2024 to 2025 is $132.6 million and 12.9%

On a regional basis, the highest growth rates over this period were in Saskatchewan where expenditures grew by 110.5% from $16.8 million in 2020-2021 to $35.3 million in 2024-2025. This was followed by Ontario with an increase of 101.5% from $15.5 million in 2020-2021 to $31.2 million in 2024-2025.

NIHB mental health counselling claimants by age group, gender and region 2024-2025

In 2024-2025 a total of 46,700 claimants, representing 5.3% of the NIHB client population, had at least 1 mental health counselling claim paid through the Health Information and Claims Processing Services (HICPS) system. Of this total, 32,018 were female (68.6%) and 14,682 were male (31.4%). This compares to the total eligible population where 51% were female and 49% were male.

These figures underrepresent mental health counselling utilization because they do not include clients accessing mental health counselling benefits delivered through contribution agreements or through travelling provider arrangements. Clients in Nunavut and Northwest Territories, where mental health counselling services are funded via contribution agreements, are not included in this calculation.

The average age of mental health counselling claimants was 32 years. The average age for female and male claimants was 33 and 31 years respectively.

NIHB mental health counselling utilization rates by region

Utilization rates reflect the number of clients who, during the fiscal year, received at least 1 mental health counselling service paid through the HICPS system as a proportion of the total number of eligible clients.

In 2024-2025, the national utilization rate for mental health counselling benefits paid through the HICPS system was 5%. NIHB mental health counselling utilization rates in 2020-2021 are artificially low as the data for that year are incomplete.

The rates understate the actual level of utilization as the data do not include mental health counselling services provided through contribution agreements and benefits provided through community health facilities or other Indigenous Services Canada. Note that mental health counselling utilization in the North is unavailable as mental health counselling services for clients in Nunavut and Northwest Territories are funded via contribution agreements.

Atlantic region

Annual expenditures in the Atlantic region for 2024-2025 totalled $113.5 million, an increase of 11.0% over the $102.3 million spent in 2023-2024. Pharmacy expenditures increased by 12.6 to $55.7 million, medical transportation costs decreased by 2.4 to $17.8 million and dental expenditures increased by 10.9% to $16.0 million. Mental health expenditures increased by 15.1%, MS&E expenditures increased by 4.5% and vision care expenditures decreased by 1.4%.

Pharmacy expenditures accounted for almost half of NIHB expenditures in the Atlantic region at 49.1%. Medical transportation expenditures ranked second at 15.7%, followed by dental at 14.1%. MS&E, vision care and mental health counselling expenditures accounted for 5.0%, 7.9% and 4.7% of total expenditures, respectively.

Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 10.1: Percentage change in Atlantic region NIHB expenditures (Hundred Thousands of dollars$ 000's)

This image is a stacked bar graph which visually describes NIHB expenditures and annual percentage change in the Atlantic region, as follows:

Atlantic region	2015-2016	2016-2017	2017-2018	2018-2019	2019-2020	2020-2021	2021-2022	2022-2023	2023-2024	2024-2025
Total expenditures ($M)	$50,773	$55,079	$60,040	$63,342	$73,071	$73,984	$84,227	$92,488	$102,281	$113,488
Total benefits annual % change	8.2%	8.5%	9.0%	5.5%	15.4%	1.2%	13.8%	9.8%	10.6%	11.0%

Quebec

Annual expenditures in Quebec for 2024-2025 totalled $153.9 million, an increase of 7.8% from the $138.0 million spent in 2023-2024.

Medical transportation expenditures increased by 14.2% to $32.6 million, pharmacy expenditures increased by 8.2% to $75.8 million and dental expenditures increased by 12.8% to $26.3 million. MS&E costs increased by 11.7%, mental health expenditures increased by 16.3% and vision care expenditures decreased by 1.4%.

Pharmacy expenditures accounted for half of total NIHB expenditures in Quebec in 2024-2025 at 49.2%. Medical transportation expenditures ranked second at 21.2%, followed by dental at 17.1%. Mental health counselling, MS&E and vision care expenditures accounted for 5.6%, 2.8% and 2.6% of total expenditures, respectively.

Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 10.2: Percentage change in Quebec NIHB expenditures (Thousands of dollars$ 000's)

This image visually describes NIHB expenditures and annual percentage change in Quebec, as follows:

Quebec	2015-2016	2016-2017	2017-2018	2018-2019	2019-2020	2020-2021	2021-2022	2022-2023	2023-2024	2024-2025
Total expenditures (Hundred Thousands of dollars$ 000's)	$87,690	$91,831	$94,210	$96,120	$104,136	$103,773	$117,373	$128,017	$138,032	$153,872
Total benefits annual percentage change	3.6%	4.7%	2.6%	2.0%	8.3%	-0.3%	13.1%	9.1%	7.8%	11.5%

Ontario

Annual expenditures in Ontario for 2024-2025 totalled $454.0 million, an increase of 9.4% from the $414.8 million spent in 2023-2024.

Medical transportation expenditures in Ontario increased by 11.7% to $185.5 million, while pharmacy costs increased by 9.2% to $131.0 million and dental expenditures increased by 4.5% to $82.5 million. Mental health counselling expenditures increased by 13.8%, while MS&E increased by 10.7% and vision care expenditures increased by 0.7%.

Medical transportation expenditures accounted for 40.9% of total expenditures for Ontario. Pharmacy costs ranked second at 28.9%, followed by dental at 18.2%. Mental health, MS&E and vision care expenditures accounted for 6.9%, 2.9% and 2.2% of total expenditures respectively.

Source: FST and FIRMS adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 10.3: Percentage change in Ontario NIHB expenditures (Hundred Thousands of dollars$ 000's)

This image is a stacked bar graph which visually describes NIHB expenditures and annual percentage change in Ontario, as follows:

Ontario	2015-2016	2016-2017	2017-2018	2018-2019	2019-2020	2020-2021	2021-2022	2022-2023	2023-2024	2024-2025
Total expenditures (Hundred Thousands of dollars$ 000's)	$215,738	$231,663	$250,947	$269,127	$287,643	$273,987	$325,494	$365,069	$414,797	$453,992
Total benefits annual percentage change	6.3%	7.4%	8.3%	7.2%	6.9%	-4.7%	18.8%	12.2%	13.6%	9.4%

Manitoba

Annual expenditures in Manitoba for 2024-2025 totalled $573.2 million, an increase of 13.9% from the $503.1 million spent in 2023-2024. Medical transportation expenditures in 2024-2025 increased by 16.4% to $304.3 million, while pharmacy costs increased by 9.4% to $140.3 million. Dental expenditures increased by 14.0% to $78.6 million. Mental health counselling and MS&E expenditures increased by 17.6% and 11.2% respectively while vision care decreased by 3.9%.

Due to the higher proportion of clients living in northern or remote communities in Manitoba, medical transportation expenditures comprised more than half of total expenditures in Manitoba at 53.1%. Pharmacy costs ranked second at 24.5%, followed by dental at 13.7%. Mental health counselling, MS&E and vision care expenditures accounted for 4.1%, 3.0% and 1.4% of total expenditures respectively.

Source: FST and FIRMS, adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 10.4: Percentage change in Manitoba NIHB expenditures (Hundred Thousands of dollars$ 000's)

This image is a stacked bar graph which visually describes NIHB expenditures and annual percentage change in Manitoba, as follows:

Manitoba	2015-2016	2016-2017	2017-2018	2018-2019	2019-2020	2020-2021	2021-2022	2022-2023	2023-2024	2024-2025
Total expenditures ($M)	$258,077	$291,989	$308,208	$320,953	$351,983	$337,517	$391,177	$451,799	$503,072	$573,171
Total benefits annual % change	7.9%	13.1%	5.6%	4.1%	9.7%	-4.1%	15.9%	15.5%	11.3%	13.9%

Saskatchewan

Annual expenditures in Saskatchewan for 2024-2025 totalled $447.4 million, an increase of 13.7% from the $393.3 million spent in 2023-2024.

NIHB pharmacy expenditures increased in Saskatchewan by 8.0% to $148.4 million, while medical transportation costs increased by 18.7% to $137.6 million. Dental cost increased by 11.4% to $87.0 million. Mental health counselling, MS&E and vision care costs increased by 10.8%, 18.4% and 7.4% respectively.

Pharmacy expenditures comprised the largest portion of total NIHB expenditures in Saskatchewan at 33.2%, medical transportation costs ranked second, at 30.8%, followed by dental at 19.4%. Mental health, MS&E and vision care expenditures accounted for 7.9%, 4.7% and 2.7% of total expenditures respectively.

Source: FST and FIRMS, adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 10.5: Percentage change in Saskatchewan NIHB expenditures (Hundred Thousands of dollars$ 000's)

This image is a stacked bar graph which visually describes NIHB expenditures and annual percentage change in Saskatchewan, as follows:

Saskatchewan	2015-2016	2016-2017	2017-2018	2018-2019	2019-2020	2020-2021	2021-2022	2022-2023	2023-2024	2024-2025
Total expenditures (Hundred Thousands of dollars$ 000's)	$193,502	$220,352	$247,997	$265,082	$290,386	$286,028	$335,584	$363,319	$393,315	$447,356
Total benefits annual percentage change	7.5%	13.9%	12.5%	6.9%	9.5%	-1.5%	17.3%	8.3%	8.3%	13.7%

Alberta

Annual expenditures in Alberta for 2024-2025 totalled $316.7 million, an increase of 9.9% from the $288.1 million spent in 2023-2024. Medical transportation expenditures increased by 14.4% to $79.5 million, while pharmacy costs increased by 7.7% to $110.4 million. Dental expenditures increased by 11.2% to $82.8 million. Mental health counselling and MS&E expenditures increased by 11.7% and 2.6% while vision care expenditures decreased by 2.2%

Pharmacy expenditures accounted for 34.9% of total NIHB expenditures in Alberta. Dental costs ranked second at 26.2%, followed by medical transportation at 25.1%. Mental health counselling, MS&E and vision care expenditures accounted for 6.4%, 4.4% and 2.9% of total expenditures respectively.

Source: FST and FIRMS, adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 10.6: Percentage change in Alberta NIHB expenditures (Hundred Thousands of dollars$ 000's)

This image is a stacked bar graph which visually describes NIHB expenditures and annual percentage change in the Alberta region, as follows:

Alberta	2015-2016	2016-2017	2017-2018	2018-2019	2019-2020	2020-2021	2021-2022	2022-2023	2023-2024	2024-2025
Total expenditures (Hundred Thousands of dollars$ 000's)	$168,211	$183,108	$192,983	$209,122	$232,177	$222,953	$248,869	$271,783	$288,092	$316,744
Total benefits annual percentage change	5.8%	8.9%	5.4%	8.4%	11.0%	-4.0%	11.6%	9.2%	6.0%	9.9%

Northern region

Annual expenditures in the Northern region for 2024-2025 totalled $230.1 million, an increase of 3.9% from the $221.5 million spent in 2023-2024. Medical transportation expenditures decreased by 5.4% to $122.9 million while pharmacy costs increased by 12.6% to $40.4 million. Dental expenditures increased by 24.9% to $48.2 million. MS&E and vision care costs increased by 22.4% and 1.3% respectively while mental health counselling costs decreased by 2.5%

As with Manitoba, medical transportation expenditures comprised the largest portion of total NIHB expenditures in the Northern region at 53.4%. Dental costs ranked second at 20.9%, followed by pharmacy at 17.6%. MS&E, vision care and mental health counselling expenditures accounted for 3.7%, 2.2% and 2.0% of total expenditures respectively.

Source: FST and FIRMS, adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 10.7: Percentage change in Northern region NIHB expenditures (Hundred Thousands of dollars$ 000's)

This image is a stacked bar graph which visually describes NIHB expenditures and annual percentage change in the Northern region, as follows:

Northern region	2015-2016	2016-2017	2017-2018	2018-2019	2019-2020	2020-2021	2021-2022	2022-2023	2023-2024	2024-2025
Total expenditures (Hundred Thousands of dollars$ 000's)	$102,040	$109,157	$126,933	$134,474	$142,961	$157,664	$162,080	$181,796	$221,469	$230,077
Total benefits annual percentage change	8.2%	7.0%	16.3%	5.9%	6.3%	10.3%	2.8%	12.2%	21.8%	3.9%

Non-insured health benefits administration costs (Hundred Thousands of dollars$ 000's) 2024-2025

Table 11.1 outlines program administration expenditures by region and at NIHB headquarters (HQ) costs. In 2024 to 2025, total NIHB administration costs were $93.0 million, an increase of 6.9% over the previous fiscal year.

Claims processing contract costs are related to the administration of pharmacy, medical supplies and equipment, dental benefits, mental health counselling and vision care benefits through the Health Information and Claims Processing Services (HICPS) system.

Non-Insured Health Benefits administration costs as a proportion of benefit expenditures ($ millions)

In 2024-2025, total NIHB benefit expenditures were $2,330.7 million, of which direct benefit expenditures totalled $2,309.57 million and expenditures for claims processing administration amounted to $21.1 million. An additional $71.8 million was spent on salaries and operating costs associated with program administration. Some administrative costs paid within contribution agreements are not captured in these data.

Total NIHB program administration costs ($93.0 million, including claims processing and other program administration) as a proportion of direct benefit expenditures ($2.3 billion) was 4.0% in 2024-2025. Over the past 5 fiscal years, the percentage of NIHB program administration costs as a proportion of total benefit expenditures has ranged from a high of 5.0% in 2020-2021 to a low of 3.9% in 2022-2023.

Source: FST and FIRMS, adapted by Program Analytics and Risk Mitigation

Text alternative for Chart 11.1: Non-Insured Health Benefits administration costs as a proportion of benefit expenditures ($ millions)

This image is a bar graph which visually describes NIHB program expenditures and the percentage of which are administrative costs, as follows:

Fiscal year	NIHB benefit expenditures ($ millions)	Percentage administrative costs
2020-2021	$1,490.6	5.0%
2021-2022	$1,695.3	4.2%
2022-2023	$1,891.7	3.9%
2023-2024	$2,098.1	4.2%
2024-2025	$2,330.7	4.0%

Health Information and Claims Processing Services 2024-2025

Claims for NIHB pharmacy, dental, MS&E, as well as most mental health counselling and vision care benefits provided to eligible First Nations and Inuit clients are processed via the Health Information and Claims Processing Services (HICPS) system. HICPS includes administrative services and programs, technical support and automated information management systems that are used to process and pay claims in accordance with NIHB program client or benefit eligibility and pricing policies.

Since 1990, the NIHB program has retained the services of a private sector contractor to administer the following core claims processing services on its behalf:

• claim processing and payment operations
• claim adjudication and reporting systems development and maintenance
• provider registration and communications
• provider audit programs and audit recoveries
• standard and ad hoc reporting

The current HICPS contract is with Express Scripts Canada. This contract came into force on June 28, 2020, following a competitive contracting process led by Public Services and Procurement Canada (PSPC). The NIHB program manages the HICPS contract as the project authority in conjunction with PSPC, the contract authority.

Number of active providers registered in the Health Information and Claims Processing Services system 2024-2025

Benefit providers can register with Express Scripts Canada to provide benefits to NIHB clients and bill the program directly. An active provider is a provider who is registered and has submitted at least 1 claim in the 24 months prior to March 31, 2025.

As of March 31, 2025, there were 47,242 active pharmacy, dental, MS&E, mental health counselling and vision care providers. The number of active providers by region and by benefit is outlined in the table below.

Number of claim lines settled through the Health Information and Claims Processing Services system 2024-2025

During 2024-2025, more than 36 million claim lines for pharmacy, dental, MS&E, vision care and mental health counselling benefits were processed through HICPS. Ontario had the highest volume of claims processed at 9.1 million, followed by Alberta at 7.5 million and Manitoba at 6.8 million.

Claims verification activities 2024-2025

As part of risk management activities for the NIHB program, Indigenous Services Canada mandates its claims processor to maintain a set of pre-payment and post-payment processes, including claims verification activities.

During 2024-2025, the claims processor carried out claims verifications as directed by the NIHB program. These verifications address the need of the NIHB program to comply with accountability requirements for the use of public funds and to ensure provider compliance with the terms and conditions of the program as outlined in the appropriate NIHB Benefit Guide, Claims Submission Kit, Provider Billing Agreement and other relevant documents.

There are 5 components within claims verification activities for the pharmacy, medical supplies and equipment, dental benefit, vision care, and mental health counselling areas. These are:

• Daily Claim Verification Program consists of a review of a defined sample of claims submitted by providers the day following receipt by the claims processor
• Client Confirmation Program consists of a monthly mail-out to NIHB clients to confirm the receipt of services that have been paid on their behalf
• On-Site Claim Verification Program consists of the selection of a sample of claims for administrative validation against a provider's records through an on-site visit
• Desk Claim Verification Program consists of the selection of a sample of claims for administrative validation against a provider's records and conducted at a distance
• Financial Recovery Program consists of a focused recovery assessment

The following figure identifies recoveries from all components of the claims verification process during the 2023-2024 fiscal year.

Completion of a verification process often spans more than 1 fiscal year. Recoveries from claims verification activities are recorded in the fiscal year in which they are received. Subsequent appeals to reversals may result in claim payment if confirmed services comply with the terms and conditions of the NIHB Program.

Collaboration with First Nations and Inuit partners

Indigenous Services Canada (ISC) is engaged in a multi-year joint review of the NIHB program in partnership with the Assembly of First Nations (AFN). The overall objectives of the review are to identify and implement actions that enhance client access to benefits, identify gaps in benefits, streamline service delivery to be more responsive to client needs, and increase program efficiencies. The AFN conducted a robust program of client, provider and stakeholder engagement activities to gather broad input and perspectives that will inform recommendations for program improvements. The joint review is guided by a Steering Committee comprised of First Nations and ISC representatives.

As of March 31, 2024, joint reviews of the mental health counselling, dental, vision care, pharmacy and medical supplies and equipment benefits are complete and the review of the medical transportation benefit is in progress. Meanwhile, the NIHB Program continues to implement many improvements to benefit coverage and administration. For more information on the Non-insured Health Benefits program joint review, including highlights of changes and improvements made by NIHB throughout the process, visit us on the web.

Indigenous Services Canada continues to work with the Inuit Tapiriit Kanatami (ITK) to improve the quality, access, and delivery of NIHB benefits to Inuit clients. NIHB and ITK representatives meet regularly to discuss issues of concern and identify opportunities for improvement. In January 2023, NIHB and ITK established a new engagement table including representatives of the National Inuit Committee on Health to discuss priorities and concerns for Inuit NIHB clients. NIHB shares information and regularly updates Inuit partners on progress made to advance priorities identified by Inuit partners.

Client and provider communications

NIHB is continually seeking ways to improve communications with clients, providers and partners regarding benefit coverage and administration.

The NIHB program regularly produces newsletters and updates to inform clients and providers about any changes to NIHB policy and benefit coverage. For example, NIHB enrolled providers for dental, pharmacy, MS&E, vision care and mental health counselling receive notification of policy updates and relevant information regarding benefits through regular provider newsletters, periodic bulletins and broadcast messages.

These communications are distributed to enrolled providers by Express Scripts Canada (ESC), Indigenous Services Canada's claims processing contractor, and are available via the ESC website at: nihb.express-scripts.ca.

The Government of Canada website is a key venue for sharing NIHB program information to clients. NIHB program updates are produced quarterly and as needed to provide information for clients regarding changes to benefit coverage. Clients can subscribe to receive email notifications when these updates are published, and those who have set up web accounts through Express Scripts Canada also receive notification of new updates. Client-focused communications are also promoted through social media on the Government of Canada's Healthy First Nations and Inuit Facebook page and GCIndigenous X (formerly called Twitter) account. Additional social media posts promote client awareness of benefit coverage, often in conjunction with broader public health promotion campaigns. For example, a post on diabetes awareness will include a reminder about NIHB coverage of diabetes medications and supplies, and a post on vision health may include a reminder about NIHB coverage of eye exams.

NIHB strives to be accessible and responsive to clients. Clients can contact NIHB directly by calling Indigenous Services Canada regional offices, the NIHB Dental Predetermination Centre, or the NIHB Drug Exception Centre. The Contact us web page for the NIHB program also provides an email address for direct inquiries to the NIHB program.

NIHB Navigators

NIHB Navigators help eligible clients to navigate and access the NIHB program. They are a resource for communities, organizations or individuals who need support or information on NIHB-related issues. Navigators are employed by regional First Nations and Inuit organizations. Their roles and activities are adapted to meet regional needs and generally include the following:

• increase understanding of the NIHB program and share information on eligible benefits
• help clients and communities to resolve NIHB-related issues
• link with health departments and agencies to help improve client access to NIHB benefits and related health services

NIHB program representatives regularly engage with Navigators and support them in their work by sharing program information, responding to inquiries and assisting with client cases. Navigators also provide valuable support to the program by sharing their insight on client experiences and working collaboratively to improve client-focused service.

Population data

First Nations and Inuit population data are drawn from the Status Verification System (SVS), which is operated by NIHB. SVS data on First Nations clients are based on information provided by the Registrar's office of Indigenous Services Canada. SVS data on Inuit clients are based on information provided by the Governments of Northwest Territories and Nunavut, and Inuit land claim organizations including the Inuvialuit Regional Corporation, Nunavut Tunngavik Incorporated and the Makivik Corporation.

Pharmacy, MS&E, dental, mental health counselling and vision care data

Two Indigenous Services Canada data systems provide information on the expenditures and utilization of the NIHB pharmacy, MS&E, dental, vision care and mental health counselling benefits. Financial Services and Training (FST) is the source of most expenditure data, while the Health Information and Claims Processing Services system provides detailed information on utilization. Expenditure data prior to fiscal year 2019-2020 were collected from the Framework for Integrated Resource Management System.

Medical transportation data

Medical transportation financial data are provided through FST. Medical transportation data are also collected regionally through other electronic systems. Operational data at the regional level are tracked through the Medical Transportation Reporting System (MTRS). Contribution agreement data are also collected, but in a limited manner. In some communities, MTRS is used to collect contribution agreement data, while other communities report data using spreadsheet templates, in-house data management systems, or through paper reports.

The Medical Transportation Data Store serves as a repository for limited operational data, as well as the data collected from medical transportation contribution agreements and ambulance data systems.