NIHB Professional Services
Refusal To Fill Fee
A pharmacy provider in British Columbia, Saskatchewan, or Manitoba may decide not to fill or refill a prescription when a claim has been rejected through the Drug Utilization Review and it is deemed to be in the best interest of the client. In these cases, a fee equal to the providers usual and customary fee may be charged to the NIHB Program. The provider is advised to use the 'UL' intervention code on his claim.
Trial Rx Program
In British Columbia and Saskatchewan, the NIHB Program may cover the dispensing fee associated with the provision of a small initial quantity of a 'trial drug' (seven-day supply) that is included under the Trial Prescription Program. To be applicable for reimbursement, the client must not have used the drug in the past two years.
Opioid Dependence Treatment
- The dispensing fee for methadone will be based upon the following formula (usual and customary dispensing fee*/7) + $5.10 per dose.
- * Up to the Program’s regional maximum.
Suboxone & Kadian
- Usual and customary dispensing fee* per dispense.
- (A separate reimbursement for witnessing the ingestion of Suboxone or Kadian via pseudo DIN 91500002 will no longer be available.)
- * Up to the Program’s regional maximum.
Opioid Dose Escalation Limit & Update on Compensation for Opioid Treatment
NON-INSURED HEALTH BENEFITS PHARMACY POLICY CHANGE:
OPIOID DOSE ESCALATION LIMIT & UPDATE ON COMPENSATION FOR OPIOID TREATMENT (METHADONE, SUBOXONE AND KADIAN)
This document is only available to Association
NIHB Prescriber Policy
Drug Benefits List and are within pharmacist’s scope of practice. Schedule II, III and unscheduled (non-prescription) drugs and eligible health products (eg. spacer devices and diabetic supplies) which are on the NIHB
3.12 Prescriber Policy for Pharmacy Benefits
In order to be eligible for reimbursement, the following conditions must be satisfied by all prescribers:
• licensed by and in good standing with the respective governing body or province in which they practice
• the prescription has been written in accordance with federal and provincial legislation
• the prescription falls within the health professional's scope of practice, as defined by the relevant provincial and territorial regulations
In addition, the NIHB Program accepts client-specific written recommendations for Schedule II, III and unscheduled (non-prescription) drugs and eligible health products that are not included on a health professional's prescribing list, when the item(s) falls within the prescriber’s scope of practice. The NIHB Program requires providers to maintain documentation related to claims submitted as a result of a health professional’s recommendation.
At a minimum this must include the following information:
• name, and address or date of birth of the client
• proper name, common name, or brand name of the prescribed drug, and the quantity thereof
• amount recommended
• signature of the health professional
Although not explicitly required by NIHB policy, PAS is recommending to document the clinical indication to prevent audit claw back. Claims submitted according to this policy will be reimbursed for the drug cost and dispensing fee according to NIHB reimbursement policies. Claims submitted according to this policy will be reimbursed for the drug cost and dispensing fee according to NIHB reimbursement policies. All claims are subject to claims verification. The NIHB Program does not compensate pharmacists for client assessment services.
Schedule II, III and unscheduled (non-prescription) drugs and eligible health products that are included within the NIHB Drug Benefits List that would not be considered in a pharmacist’s scope of practice include but are not limited to items such as Ensure , Boost
The NIHB Prescriber Policy does not allow pharmacists to recommend Medical Supplies and Equipment (MS&E) such as bandages, dressing, pressure garments, etc. The MS&E policy is a different policy with a different
For more information
- All pharmacy benefit related bulletins and policy can be found here
- All MS&E benefit related bulletins and policy can be found here
- here Pharmacists can sign up for NIHB updates, direct to their personal email
o view their benefit claims history and status of pending requests
o submit client reimbursement requests online
o submit appeal requests online
receive NIHB communication directly by email