The following information is an update from the Non-Insured Health Benefits (NIHB) Program for December 2021.

You can print a PDF copy of this information here.

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 2-19 years of age on intensive insulin (short-acting insulin three 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.

o Items are listed in tables that identify eligible prescribers/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:

o once a year for clients up to 17 years of age

o every two 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.

o 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

o 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

  • As a reminder, NIHB covers low vision aids, including magnifiers and canes, under the medical supplies and equipment benefit
  • For more information, consult the low vision equipment and supplies benefit list or contact your NIHB regional office

General program information

Important reminder: client reimbursement

  • NIHB client reimbursement claims for the following benefits must be submitted to Express Scripts Canada:

o pharmacy

o dental

o medical supplies and equipment

o vision care

o 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
  • Use the NIHB medical transportation client reimbursement form and send it to your NIHB regional office

NIHB client inquiries

Email [email protected]




Medical Transportation: 1-877-983-0911

Pharmacy benefits

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, medical supplies and equipment, vision care and mental health counselling benefits.