Medical Transportation
Effective April 17, 2023, the First Nations Health Authority (FNHA) is launching an updated Medical Transportation (MT) Benefit Schedule. The updates include:
- Closest Appropriate Provider Definition
Based on the feedback from communities across the province, the FNHA has clarified the language for the Closest Appropriate Provider and the conditions for Exception coverage requests. These changes include:
- The Exception process will continue to support Patient Travel (PT) clerks in the determination of the Closest Appropriate Provider.
- Exceptional travel requests to providers that are not considered closest are adjudicated on a case-by-case basis, with consideration of wait times, availability of qualified medical professionals, and travel distance and/or cost.
- The Exception process now also considers reported instances of culturally unsafe events in the determination the Closest Appropriate Provider.
- Escort for Clients in Hospital
Requests for Escort for Clients in Hospital continue to be evaluated on a case-by-case basis. Claims submitted through the Exception process focus on the unique condition of each client and the medical need for an Escort while a Client is in the hospital. These changes include:
- Escort coverage when a Client is in hospital may be extended beyond three weeks when medically or legally necessary.
- Health Benefits may require documentation to support the adjudication of exceptional coverage requests beyond three weeks.
- Coverage requests beyond three weeks and based on a medical need will be reviewed by FNHA physician(s).
- New MT User Guide
The FNHA Team has developed a User Guide to support PT clerks in evaluating client eligibility, assessing benefits and booking travel. The guide will supplement the Benefit Schedule along with training already provided.
- MT Mileage rate update
Effective April 1, 2023, the FNHA extended the Temporary MT mileage rate of $0.29 until Sept. 30, 2023. Learn more.
Dental Benefits
Effective April 17, 2023, there will be changes to the following:
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Dental Lab Fee
- The FNHA is adopting the Pacific Blue Cross (PBC) standard for paying lab fees (certain repair and fabrication fees) billed by providers. This change brings the FNHA plan in line with industry standards.
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Crown and Bridge coverage
- Restorative services will be bundled (onlays, crowns and veneers) to count toward a four-unit limit per calendar year.
- Prosthodontics (bridges) will have a separate dollar limit of $5,000 per calendar year.
The existing $4,500 per five-year review threshold remains in place, in addition to the changes listed above. Any approved pre-determinations prior to the change will be honored. Your dental provider will have information about approved pre-determinations and any existing treatment plan that is in place.
For more information, please visit the PBC app or call Health Benefits 1-855-550-5454.
Pharmacy Benefit and Plan W Changes
The FNHA provides pharmacy benefits for First Nations people in British Columbia (BC) through partnership with BC PharmaCare and PBC. PharmaCare Plan Wellness (Plan W) is the drug benefit plan for FNHA clients.
The FNHA continues to work with its partners to improve pharmacy benefits to meet the unique health needs of First Nations people in BC.
The following are recent changes to Plan W coverage and pharmacy benefits:
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Changes to Diabetes Medications Coverage
- As of Jan. 5, 2023,
Dapagliflozin is now a regular benefit included in Plan W. Prescribers are no longer required to apply for Special Authority (SA) coverage for this medication.
- Coverage for
Empagliflozin and
Semaglutide has also been expanded. Prescribers can now apply for SA coverage for these second-line therapies if metformin alone is inadequate for blood sugar control.
FNHA members who reside in BC, but receive services at a provider along the Yukon or Alberta border are provided coverage through PBC. PBC is actively working on implementing coverage changes for Empagliflozin and Semaglutide and will confirm implementation when complete.
Please contact us at the number below for coverage related questions.
These changes improve access to medications that work to lower blood sugar levels in adults with Type 2 diabetes. The Summary of Diabetes Drugs, Insulins, and Supplies Coverage for FNHA Clients has been updated to reflect these changes.-
Change to Apixaban Coverage
- As of Jan. 5, 2023,
Apixaban is now a regular benefit in Plan W. Apixaban is a blood thinner used to treat blood clots. Prescribers are no longer required to apply for SA coverage for this medication. This change will help to reduce coverage issues from occurring when clients are starting on this medication, for example, after hospital discharge.
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Easier access to Sublocade® to treat Opioid Use Disorder
- As of March 14, 2023, Buprenorphine XR injection (Sublocade®), a monthly injection used to treat opioid use disorder, is now easier to access. Prescribers are no longer required to apply for SA coverage.
Clients are encouraged to have annual medication reviews with their pharmacist to discuss their chronic medications, make sure the medications are working well, and improve understanding of their medication regimens. Clients who do not have access to a trusted local pharmacist can set up a phone or video appointment to speak with a pharmacist.
For more information, please contact Health Benefits at 1-855-550-5454.
