Understanding Plan Wellness (Plan W): 5 helpful tips

Updated on April 25, 2018 (Originally posted on March 4, 2018) The Tablet
Laura and Sid Sam

Tofino pharmacist Laura McDonald works with many First Nations Health Authority clients. She helped train other community pharmacists on the switch to PharmaCare's Plan Wellness (Plan W). Above: Community pharmacist Laura McDonald with patient Sid Sam, Jr. of the Ahousaht First Nation.

On Oct. 1, 2017, First Nations Health Authority (FNHA) clients in B.C. joined PharmaCare to receive drug benefits services through a tailored program designed specifically for First Nations called Plan Wellness (Plan W). Formerly, these patients received drug coverage from Health Canada’s Non-Insured Health Benefits (NIHB) program. This change is the first step in improving First Nations health care by bringing it closer to home in B.C. All FNHA clients who are eligible for the BC Medical Services Plan (MSP) are eligible for PharmaCare Plan W benefits.

In support of this province-wide change, the BC Pharmacy Association contracted pharmacist and owner of Pharmasave Tofino, Laura McDonald, to develop training materials and conduct community engagement sessions in several First Nations communities across B.C., including in Prince Rupert, Terrace, Prince George and Hazelton.

While B.C. is McDonald’s adopted home province, she is truly west coast at heart. For the past 10 years, McDonald has fully integrated herself into the Tofino community as an avid, year-round surfer and proactive member of an integrated health-care team. In addition to serving her many patients at Pharmasave, McDonald makes regular visits to the nearby community of the Tla-o-qui-aht First Nation, conducting health presentations, medication reviews, safe disposals, as well as fulfilling prescriptions. 

“In this setting I am often invited to eat and share a meal with the community’s elders and families,” says McDonald. “It’s a privileged experience to have.”

For The Tablet, McDonald discusses the top five challenges pharmacists may face when interacting with PharmaCare’s newly launched Plan W.

1. Special Authority process

Following the introduction of Plan W, the timeframe for receiving Special Authority status for your patients may have increased, in some cases from the regular 10 days to up to three weeks. As of April 2018, the timeframe has been restored back to normal. PharmaCare has expanded their resources in the SA department and included a practitioner-only telephone number: 1-866-905-4912. For urgent SA, the one business day turnaround time is being met and for priority medications turnaround time is three business days.

2. Special Authority expiry dates

The expiries of transitional SA are specific to each drug. Many SA’s are indefinite. For drugs that require renewal, prescribers will need to apply for SA within four to six months from Oct. 1. To figure out if this is the case for your patient, while in the process of adjudicating a drug to PharmaCare, SA expiry date should appear on the adjudication screen. In addition, pharmacists can call 1-800-554-2225 to see if a patient’s SA has an expiration date. 

3. FNHA transitional coverage request form

To ensure continuity of drug coverage, the transitional coverage request form is a one-time fill per drug, per patient. During the interim period of Oct. 1, 2017 to July 31, 2018 (formerly Feb. 28, 2018, but was extended), pharmacists are reimbursed a $10 fee in addition to the usual drug cost plus dispensing fee. Ensure to review your invoices as some of the $10 additional fees were missed. Pharmacists can re-submit the form via fax indicating that the missing service fee was not included in the original cheque. Or pharmacists can email healthbenefits@fnha.ca the information.

4. Plan W non-drug OTC reimbursement

Curious about the correct reimbursements for the Plan W non-drug OTC benefits? The correct information is that PharmaCare reimburses cost plus markup (retail pricing) for non-drug OTC benefits (i.e. lancets, alcohol swabs and aerochambers). If you notice a price discrepancy, please contact Health Insurance BC (HIBC) and submit an itemized invoice to request a price adjustment.

5. Support calls for PharmaCare vs FNHA

PharmaCare’s help desk should be the first point of contact for all claim coverage issues. This is not an inclusive list but common reasons to reach out to PharmaCare include: benefit inquiries, SA requests and pricing discrepancies. FNHA call centre is used to help support patients if PharmaCare cannot resolve the issue (i.e. Plan W registration, “grandfathered” drugs being missed and an exceptional process for appeals). FNHA is the resource for emergency situations; they are committed to ensuring all patients receive the medications they need.

This article is featured in The Tablet. The Tablet features pharmacy and industry news, profiles on B.C. pharmacists, information on research developments and new products.