**NEWSLETTER ON THE FNQLHSSC**

  * 2016 NIHB Progress List 



The Assembly of First Nations (AFN) and the First Nations and Inuit Health Branch (FNIHB) have undertaken a Joint Review of the Non-Insured Health Benefits (NIHB) Program. Even though the AFN-FNIHB NIHB Joint Review process is expected to take two years, it has been jointly determined that improvements to policy areas and guidelines of the NIHB Program can be implemented during the analysis of the NIHB Program rather than at the end of the Joint Review process. Detailed below is the progress list outlining improvements to the NIHB Program that have been implemented by FNIHB since the beginning of the AFN-FNIHB NIHB Joint Review.

The FNQLHSSC will communicate changes to the NIHB Program as they are implemented.

# **Changes & Improvements to Benefit Coverage, **

# **Access and Policy**  
  
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**Pharmacy services** |  More than 50 products and medications have been newly added to the NIHB Drug Benefit List as open benefits, including:  
  
\- Naloxone, for treatment of opioid overdose  
  
\- Bisphosphonates, for treatment and prevention of osteoporosis and Paget disease (changed from limited use to open benefit);  
  
\- Clopidogrel (Plavix), to prevent heart attacks and blood clots;  
  
\- Levetiracetam (Keppra), for the treatment of epilepsy;  
  
\- Naltrexone (Revia), for the treatment of alcohol use disorder.  
New limited use drug benefits include:  
  
\- Invokana, and Jardiance, oral medications that can be used in the treatment of Type 2 diabetes;  
  
\- Fosrenol, a medication used to lower phosphate levels in patients with end stage kidney disease;  
  
\- Simponi, for the treatment of ulcerative colitis;  
  
\- Diclofenac, a topical treatment for osteoarthritis;  
  
\- Anoro Ellipta, Breo Ellipta, Incruse Ellipta, Spiriva Respimat and Inspiolto Respimat, medications used to treat symptoms of chronic obstructive pulmonary disease (COPD);  
  
\- Feramax, for the prevention of iron deficiency anemia in children;  
  
\- Xeljanz, an oral biologic treatment for rheumatoid arthritis;  
  
\- Cosentyx, a biologic therapy for the treatment of psoriasis;  
  
\- Giotrif, for the treatment of lung cancer;  
  
\- Iclusig, for the treatment of leukemia;  
  
\- Aptiom, to control epileptic seizures.  
FNIHB lifted the dose limit on Cymbalta, a non-opioid medication that is used to treat depression or manage pain.  
FNIHB implemented a new process to simplify approval for coverage of Suboxone to treat opioid addiction.  
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**Dental care** |  FNIHB has increased coverage for **partial** plastic (acrylic) dentures. From now on, the requests for replacement will be reviewed every five years (instead of every eight years).  
FNIHB has revised its policy for coverage of crowns and NIHB will now cover up to four crowns in a 10-year period (instead of one in a 3-year period). _Note: This change allows more flexibility to provide crowns when they are needed. Additional coverage of crowns may be provided in special cases under NIHB, such as an accident resulting in trauma to the mouth. FNIHB has worked with the Canadian Dental Association to improve communication with dental providers regarding crown coverage policy and criteria._  
Following the conclusion of the Endodontic Trial Project, as of April 1, 2016, FNIHB has permanently lifted the predetermination requirement for standard root canal treatments on bicuspids and first molars. In addition, as of December 9, 2016, FNIHB has removed the predetermination requirement for standard root canal treatments on second molars. With these changes, FNIHB has removed the predetermination requirement for standard root canals on most teeth (except for wisdom teeth).  
**Mental health counseling** |  FNIHB has revised mental health provider enrollment forms to include information on provider specialties, including trauma informed care, and cultural competency.  
FNIHB has improved the functionality of on-line forms to facilitate the claims submission process.  
FNIHB has updated the Guide to Mental Health Counseling Services to include guidelines for group counseling.  
FNIHB continues to work with communities facing crisis episodes to bring counsellors into communities under contribution agreement or contracts.  
FNIHB has reduced administration for providers by lifting the requirement for annual re-enrollment.  
It is no longer necessary to send the professional’s treatment plan to Health Canada. A simple form must be completed to access counseling sessions.  
Increased numbers of counseling sessions (maximum 20).  
**Medical equipment and supplies** |  Since October 17, 2016, the prior approval requirement for a pair of custom-made foot orthotics was temporarily lifted for one year. FNIHB will monitor provider compliance with benefit policy, and consider removing the requirement for prior approval on a permanent basis.  
Since October 2016, the reimbursement of customized foot orthotics was increased to $450.00 (replacement every two years).  
Hospital beds (electric beds) are no longer exclusions. Requests are analyzed on an individual basis (case by case) to determine the eligibility of the client with the exception.  
FNIHB now accepts prescriptions for low vision aids from optometrists in all parts of Canada.  
In partnership with other federal health plans, a new agreement was signed with the Canadian Auditory Equipment Association (CAEA). A new pricing grid for hearing aids and supplies is now in effect, increasing reimbursement rates for these items.  
New types of recognized providers for orthotics and prosthetics equipment in Quebec were added.  
**Vision care** |  NIHB now cover progressive lenses for close and distance vision correction, as an alternative to standard bifocal lenses.  
FNIHB has reduced administration for providers by lifting the requirement for annual re-enrollment.