Prescription delays for indigenous patients amount to triage by race
Eligible First Nations and Inuit people are supposed to have access to drug coverage, dental care, mental health counselling and more. So why does it take days to weeks for people to actually get their prescriptions filled? As a physician who practices in the predominantly indigenous community of Wapekeka, I’d love to see the federal government answer that question.
The Non-Insured Health Benefit (NIHB) program is a national insurance policy that provides prescription drug coverage to Status First Nations and Inuit people not covered by provincial, territorial or private insurance plans. So long as the medication they require is on an auto-approve list, the process is simple: they can immediately pick up the drug from their local pharmacy and have it covered.
Unfortunately, in two percent of claims, the drugs are not on the auto-approve list. Though that might not sound like a lot, that number represents many common medications used to treat chronic conditions such as heart disease, diabetes and asthma.
For those drugs, the process of approval through the NIHB is so slow that it can leave people waiting an unacceptably long time for their medication. Advair, an asthma drug that’s commonly used if other medications aren’t working, is one of the drugs that’s not auto-approved. I’ve prescribed it to a number of patients with fairly significant asthma, who have had to wait weeks for the approval. In the meantime, they’re having trouble with their daily activities, going multiple times to our nursing station to receive acute treatment, or even being medevaced out to the hospital 500 kilometres away.
Getting prescriptions filled through the NIHB for medications that aren’t on the auto-approve list is an arduous process. The pharmacist needs to fax a form to the physician to fill out, which requests an explanation of why the treatment is needed, and often asks for detailed medical information about the patient. This form is then faxed back to the pharmacy to send to NIHB in Ottawa. A committee then meets to decide if there is enough of a rationale for the drug to be prescribed, and lets the pharmacy know the decision. It can take weeks for patients to get their drug approved. (The NIHB also doesn’t make public how long the pre-approval processes takes, or the average duration of the lag. Given that people’s health is at stake, these data should be transparent.)
The Ontario Drug Benefit (ODB) program, which is available to non-indigenous Ontarians who are over 65 or on certain government programs, has a similar list of drugs that aren’t auto approved. However, with ODB, the physician prescribing a drug simply adds a three-digit code that indicates to the pharmacist why the drug is needed. There is no lag time for the prescription; patients receive their medication the same day. (Some drugs covered by ODB are also approved on an individual basis, but it’s a very small number compared to those covered by the three-digit code.)
Non-indigenous Canadians who are eligible for drug coverage do not have to deal with the long wait for these prescriptions that indigenous Canadians face. Patients are triaged entirely on their race, and this is a major problem.
Is the NIHB really improving patient care, if patients have to wait several days for their treatment? Why does there seem to be so much more bureaucracy in this system versus the provincial system? The NIHB claims to “complement provincial and territorial health care programs” but the program is clearly inferior to the provincial and territorial drug coverage programs non-Indigenous Canadians have access to.
Michael Kirlew is a physician who works in the Sioux Lookout region. Jai Mashru is a master’s student from the north studying Human Health and Nutritional Sciences at the University of Guelph with a goal of working in medicine.