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.
The comments section is closed.
Yes, the same argument can be made – of systemic discrimination- about the effects of physician gatekeeping that restricts access to many health care services, including imaging, specialist consultation and remedial surgery. If you look at population health statistics in this country, you will find that certain patient populations are more adversely affected than others by gatekeeping practices and by limited prescription coverage. Chronic care patients are a particular target of restricted access to health care. We also have a two tiered health care system that allows private paying patients to jump ahead of wait lists, leaving Medicare patients with 2 and 3 year waits or more for specialist care and surgeries. Physicians are leaving Medicare, and reducing their time in public health, setting up private practice instead. That is time lost to Medicare insured patients, and that lost time is not being replaced by hiring more physicians and specialists. Good for the doctors pocket books, but not good for public health.
I Respectfully disagree with the race triage description especially based on the volume of meds they cover. This is a drug plan and I think you simplify the “ease” of dealing with other plans and the wait times. I work with many including NIHB and yes waits at times can be long but our major complaint is sometimes the physician or OT not getting back to them in a timely manner, which leaves the claim in flux. We’ve all had struggles with most plans in approvals that get hung up for what seems like a long time. It comes down to “this is your plan and this is what it covers”. Anything beyond that for any plan is a crap shoot unless it follows predetermined set of steps in which case the code system kicks in.