About this Benefit
Medications and other pharmacy items and services can be an important part of preventing and managing illness. The Pharmacy Benefit is designed to meet the unique health and wellness needs of First Nations people living in British Columbia (BC). A Pharmacy Benefit factsheet is available here.
What My Benefit Covers
PharmaCare Plan W (for Wellness) is the plan for First Nations people in BC. For more information, see the PharmaCare Plan W webpage.
You must be enrolled with Health Benefits to access pharmacy benefits. If you need to enroll for the first time or want to check your enrollment, please have your status number ready and call Health Benefits at 1-855-550-5454.
How Do I Access Coverage?
When you need medications or pharmacy items to treat your health conditions or to support your wellness, the best way to avoid out-of-pocket costs is to talk to your prescriber and pharmacist about which items are fully covered by your plan.
- Talk to your prescriber about your health needs to determine if there is an appropriate medication or pharmacy item for your condition or symptoms.
- Some medications or pharmacy items need Special Authority from PharmaCare for coverage. Ask your prescriber if your medication or pharmacy item requires Special Authority.
- Talk to your pharmacist about your healthcare goals and prescription. Most pharmacy items are either fully covered or have a fully-covered alternative. If you are being asked to pay for your medication, you can ask the pharmacist if there is an alternative covered by your plan. Pharmacists may also recommend covered over-the-counter medications to treat specific conditions or symptoms.
- The pharmacist will dispense your medication and bill Plan W or PBC directly.
If you have any questions about your pharmacy benefit or how to access coverage, call Health Benefits at 1-855-550-5454.
Shingrix® Vaccine
How to access coverage for the Shingrix® vaccine
Over-the-Counter Medications
How to access Over-the-Counter Medications covered by Plan W
Travelling Outside BC?
Are you planning to travel outside of BC?
- Plan ahead and make sure you have enough medication with you to last your whole trip. Talk to your pharmacist about filling a vacation supply when you plan to travel outside BC and don't have enough medication to last your whole trip. If you need to fill a prescription in another province, you will have to pay out of pocket and request reimbursement from PharmaCare for eligible benefits. (See Reimbursements)
- If you are in a unique situation while travelling outside of the province such as taking a medication that is dispensed daily at your pharmacy, please call Health Benefits at 1-855-550-5454 and let us know so that we can arrange coverage for you.
- You can call Health Benefits at 1-855-550-5454 for support if you experience any problems at a pharmacy outside of BC.
What My Benefit Does Not Cover
Some items and services are considered Exclusions. Exclusions cannot be covered as an exception and cannot be appealed. Pharmacy benefit Exclusions include, but are not limited to:
- alternative therapies (eg, glucosamine and evening primrose oil)
- weight management drugs
- cannabis
- clinic, physician and hospital fees, including for completing a form
- drugs with investigational or experimental status
- impotence drugs
- prescriptions written by a veterinarian
- most vaccines
Note that certain public health vaccines, such as the influenza (flu) vaccine, are available at no cost to eligible BC residents. For more information, speak to your pharmacist, prescriber or your community healthcare team.
Appeals
If a coverage request for a medication or pharmacy item has been denied, you have the right to appeal the decision. Items and services that are Exclusions cannot be appealed. See the Appeals page for more information about the appeals process.
Compliments and Complaints
Pharmacists, like all other regulated health professionals in BC, are required to practice with cultural safety and humility. If you have feedback on your experience or interaction when receiving pharmacy care, you can contact FNHA's Quality Care and Safety Office.
