This update provides the latest news on Non-Insured Health Benefits (NIHB) policies and benefit coverage for First Nations and Inuit people.
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 first 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 (prior approval 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 (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 list of 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.
- Here are just a few examples of products that can be recommended by pharmacists for NIHB coverage:
- smoking cessation products
- non-medicated emollient creams (Glaxal Base and similar products) for the treatment of eczema (prior approval 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
- Switches and mounting systems
Find more information in the communication 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 benefits 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 client inquiries
Email [email protected]
Medical Transportation: 1-877-983-0911
NIHB Drug Exception Centre: 1-800-580-0950
Dental and orthodontic services
NIHB Dental Predetermination Centre 1-855-618-6291 (Dental Services)
1-866-227-0943 (Orthodontic Services)
Express Scripts Canada
NIHB Client Call Centre 1-888-441-4777
For assistance with services provided by Express Scripts Canada, including NIHB client web accounts and submission of client reimbursement requests for pharmacy, dental, MS&E, vision care and mental health counselling benefits.