How to offer the Non-Insured Health Benefits (NIHB) program in your pharmacy
June 3, 2025
Providing equitable healthcare access to Indigenous communities requires understanding and effectively implementing programs designed to address unique needs and historical barriers. In this Q&A, pharmacist and advocate for Indigenous Health, Melanie Cann, discusses Canada's Non-Insured Health Benefits (NIHB) program. This federal initiative provides coverage for medically necessary health services and supplies not covered by other health insurance plans for eligible First Nations and Inuit clients.
Cann discusses the critical role pharmacies play in this healthcare ecosystem, offering practical guidance on how pharmacy teams can successfully integrate NIHB services into their practice, including providing written recommendations to access OTC medications and vitamins without a prescription, and promote better health outcomes for these communities.
MAPflow’s Communications Director Katie MacGuire spoke with Melanie Cann from her home in Saskatoon, Saskatchewan.
Q&A:
MAPflow: How did you get into Non-Insured Health Benefits (NIHB) program advocacy work?
Melanie Cann: My kids are both First Nations, so I had to learn how the program worked for them. I grew up in Saskatchewan and I started my practice in Saskatchewan. Our community had a large Indigenous population. A large percent of my clientele had NIHB coverage, and I learned it to provide the best care I could.
MAPflow: Thanks for sharing your experience and knowledge with us. To start, what is the purpose of the Non-Insured Health Benefits (NIHB) program
Melanie Cann: We all have a part to play in truth and reconciliation with our Indigenous communities. There’s a long history that we were not all involved in, we weren't alive then, but there were harms that happened and promises that were made. Part of those promises was the provision of health care, and for First Nations and Inuit, one of the ways this is delivered is through the federally-funded Non-Insured Health Benefits (NIHB) program.
MAPflow: Why is it important for pharmacists to participate in the NIHB program?
Melanie Cann: We know that there is a significant health discrepancy right now for Indigenous residents in Canada. Many Indigenous people have not been well served by healthcare and actually, often they’ve been poorly served. As a result, there's a lack of trust and a lack of understanding of how we can work together. Having a pharmacist who understands how the NIHB insurance works, who offers truthful and open information when an Indigenous person seeks healthcare, helps to build trust and helps to optimize care.
Often the issue is that the pharmacist and their teams don't know about the NIHB program.
So taking a little bit of time to learn about the program, and understand how to access information if a patient comes in, can help an Indigenous person and their family trust in the pharmacy and healthcare in general. It's not just about how to bill a prescription, it’s about how to rebuild a healthier Canadian society.
MAPflow: So, for Pharmacists wanting to learn more and help bridge this gap in care, how does the NIHB program work?
Melanie Cann: People who are Inuit or First Nations, who have status, are covered by the federal government under non-insured health benefits. Some groups have separated from this program, the largest being all British Columbia First Nations. They're now managed provincially through Plan W, and it's billed thru Pacific Blue Cross.
NIHB provides medication and medical supplies to patients, generally at no cost based on their formulary. It's a much larger formulary than many because it covers over-the-counter products, vitamins, and medical equipment.
MAPflow: Where can a pharmacy team learn more about these benefits?
Melanie Cann: CPhA has webinars available on their website.
MAPflow: How can a pharmacy team start with NIHB?
Melanie Cann: Pharmacies can set up NIHB portals. Patients who are insured by NIHB can also set up their own portal. You can access program information, submit prior approval requests, and audit documents, all through the portal. And it makes it much faster and easier.
One of the biggest areas where pharmacists can really help is making sure they understand how the over-the-counter and vitamin written recommendations work.
If patients come in with self-identified needs, we can assess them. We can do a written recommendation for them. It's documentation like a prescription, but it's not an actual prescription. It needs to be written out with the proper requirements and then the patients can get their over-the-counter products paid for, as recommended by the pharmacist. The main thing is to document properly including:
- Date
- Name and date of birth of client
- Proper name, common name or brand name of the recommended drug and the quantity thereof
- Dosage
- Pharmacist’s signature.
For example, in Saskatchewan, any of your clients on the NIHB could be on a daily dose of vitamin D. We can manage that right in the pharmacy. It's quite quick. Same thing for Pedialyte and Ibuprofen for a sick child, or allergy medicine for seasonal allergies. This takes people out of the emergency and walk-in clinics, and opens up those places for people who we can't manage. It makes care more accessible.
MAPflow: Tell me more about how the NIHB improves access to care.
Melanie Cann: I talked with one Kokum, a grandmother in Cree, and she said she's quite upset and concerned that a lot of the young moms on their reserve have not been able to get help at the pharmacies recently. They go in and they get denied. Then they need to go to a doctor, but there's no doctor nearby.
They have to try and get rides, and sometimes the doctor is an hour away. You need money to pay for the rides, or you have to try and get a medical ride. It's challenging, right? Especially if you're a young mom and you don't have a vehicle and you don't live near healthcare. So she said a lot of the young moms have to pick. Are they going to get food, or are they going to get medication for their kids? Even though it would be quite simple to provide medication, if you understand the process.
MAPflow: Why would some pharmacy teams not provide this?
Melanie Cann: I think pharmacists sometimes think, oh, it takes too long, I don't want to deal with it. I think people are scared of NIHB audits.
MAPflow: How can the documentation be simplified?
Melanie Cann: Some pharmacies make templates for their top medications so that the written recommendation is pre-typed out on a pre-made form. So when somebody comes in, you can fill it out and then scan it in.
MAPflow: What if a pharmacy doesn’t have an Indigenous community nearby? How can they still participate?
Melanie Cann: People don't just stay in one province. They travel, especially out in the prairies and out West for powwow season. You may be in an area where people are travelling through. It's not hard to get an NIHB and Pacific Blue Cross agreement set up, and then if patients come, you can help and provide care.
MAPflow: How can a pharmacy team identify who might be qualified for NIHB coverage?
Melanie Cann: Pharmacists need to know what a status card or the insurance cards look like. It can be very hurtful when Indigenous people are told that a pharmacist doesn't bill for out of country services when they have status cards. That's happened to multiple people I know.
It’s also a good idea to have a question that the team can ask every patient that includes a list of common insurances and include NIHB like, ‘Are you covered by any additional insurance like Blue Cross and NIHB?’
MAPflow: What do you want to see pharmacies do next?
Melanie Cann: Have someone from your staff take an hour or two to learn about NIHB. Learn the program and then set it up in your pharmacy so that your team can learn it too. Have a plan for what to do if somebody comes in with this coverage. It doesn't have to be a huge investment of time. Have a starting point so that if somebody comes in, you don't give them misinformation or refuse service.
If NIHB coverage is not something that you're going to do, then learn which pharmacies in your area offer this service and refer the patients there. Don't leave them with no solution.
MAPflow: Are there any final words you want to share?
Melanie Cann: Addressing inequity, even in small steps, for one patient at a time, is a positive move.
As pharmacists, I know we're not trying to make things worse for people. We need to make sure we're informed so that we can be there and help.
Additional Resources:
Photo by Markus Winkler on Unsplash
