Drugs and pharmacy benefits
Find information about coverage for prescription drugs and over-the-counter products under the Non-Insured Health Benefits (NIHB) Program.
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About drugs and pharmacy benefits
The program covers prescription and over-the-counter medications that are:
- included on the NIHB drug benefit list, including benefits that are:
- open, which do not require prior approval
- limited use, which may be eligible for coverage if the criteria for coverage are met
- prescribed by an NIHB recognized health professional, such as a physician
Exception drugs are not listed in the drug benefit list but may be approved in special circumstances.
The program provides eligible clients with coverage for benefits not otherwise available under federal, provincial, territorial or private health insurance.
How to access drugs and pharmacy benefits
You can access the drugs and pharmacy benefits from a licensed pharmacy.
Providers who are enrolled in the program generally send in claims to bill the program directly. This means you do not have to pay a deductible or co-payment. You will need to show client identification in order for providers to bill the program directly.
Express Scripts Canada administers claims for providers on behalf of the program. This website includes:
- a provider agreement
- a claims submission kit
For more information
- Drug benefit list and updates
- Guide for Pharmacy Benefits
- Pharmacy and Medical Supplies and Equipment Benefit Non-Insured Health Benefits: Policy Framework
- The Non-Insured Health Benefits Client Safety Program (NIHB-CSP)
- Reports and publications on non-insured health benefits
- Pharmacy benefit information
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