First Nations Health Benefits (Plan W)

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Plan W is designed to meet the unique needs of B.C. First Nations. Plan W covers 100 percent of:

Plan W is funded by the First Nations Health Authority (FNHA).

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Who is eligible for Plan W?

You do not need to apply for Plan W. You must be enrolled with FNHA to be covered by Plan W. Call FNHA to enrol. FNHA will confirm your eligibility for the plan.

You are eligible for coverage under the Plan W if you:

• Have active Medical Services Plan (MSP) coverage. To enrol in MSP, contact FNHA
• Are a registered Indian under the Indian Act, or are a child under 2 years who has at least one parent who is a registered Indian under the Indian Act

Some individuals do not qualify for Plan W because they have coverage through other agreements with Canada. These include:

• A treaty and land claims agreement under the Constitution Act, 1982 (Canada) (unless that treaty and land claims agreement has been identified by the provincial Minister of Health as not resulting in ineligibility), or
• A written contribution arrangement between a First Nations organization and a government or province of Canada under which the government provides funding, and which has been identified by the provincial Minister of Health as resulting in ineligibility for enrolment

Your pharmacist submits your prescription claim online, and your BC PharmaCare coverage is applied immediately.

See general coverage policies for information about PharmaCare plans, including Plan W.

Note that FNHA clients are eligible for other PharmaCare plans if they meet the criteria for the plan(s).

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Medical supplies and equipment

PharmaCare helps pay for the following medical supplies and equipment for all eligible beneficiaries:

• Blood glucose test strips (annual quantity limits apply)
• Needles and syringes for diabetics who inject insulin
• Insulin for diabetics who need it 
• Ostomy supplies for patients who have undergone ostomy surgery and need an external pouch

Some supplies and equipment are covered only under specific medical conditions. Your prescriber must submit a Special Authority request for the following items to be fully covered under Plan W:

• Insulin pumps for diabetic patients who need insulin
• Insulin pump supplies for diabetic patients with an insulin pump
• Continuous/flash glucose monitors

For Plan W only, PharmaCare also helps pay for over-the-counter supplies at their retail price up to a certain maximum, with no dispensing fee:

Medical supplies and equipment benefits that need prior authorization from the FNHA are administered by Pacific Blue Cross. See the list of FNHA MS&E benefits.

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Over-the-counter drugs

To be eligible for coverage for many over-the counter (OTC) drugs, you will need:

• A prescription from your physician, nurse practitioner or midwife
  OR
• A recommendation from your pharmacist

For all covered OTCs, your pharmacist must submit a claim to PharmaCare at the time of purchase.

How to access OTC medications covered by Plan W

You can get a medication from the Plan W OTC list in two ways:

• A prescription from a doctor or nurse practitioner, or
• A recommendation from a pharmacist

How to get a prescription

1. Talk to your doctor or nurse practitioner about your health condition
2. They may write you a prescription for an OTC medication covered by Plan W
3. Fill the prescription at your local pharmacy at no cost

How to get a pharmacist recommendation (no prescription required)

1. Talk to your pharmacist about your health condition
2. The pharmacist assesses if a safe and effective OTC therapy can treat your condition
3. Pharmacist recommends a Plan W OTC
4. Pharmacist completes the OTC Recommendation Form
5. The pharmacist dispenses the OTC item to you at no cost
6. The pharmacist asks you to sign the recommendation form to confirm that:

• they gave you an OTC medication and
• they provided the information you need for your wellness

If the pharmacist can’t recommend an OTC

Sometimes a pharmacist is not able to recommend an OTC medication covered by Plan W. This could be because the side effects of an OTC item may outweigh the potential benefits, or your symptoms may require longer-term treatment, or a prescription or non-pharmaceutical treatment would be better.

In this case, the pharmacist can discuss your options and may refer you to your prescriber, clinic or hospital for further assessment.

As with all medications, it’s important to ask the pharmacist about what to expect from an OTC treatment and when to follow-up with the pharmacist or another healthcare provider.

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Medications and devices purchased in other provinces

PharmaCare is B.C.'s provincial drug program, so Plan W cannot automatically cover drug purchases made outside the province. We recommend you get the maximum amount of medication under the PharmaCare Travel Supply Policy before you leave B.C.

If you must purchase medication in another province, you will need to send an Out-of-Province Claim (PDF, 91.7KB) to PharmaCare with your original pharmacy receipt.

Don’t have the original pharmacy receipt? You can request an official duplicate from the pharmacy. Note that till receipts or photocopies cannot be accepted.

Pharmacies along the border: Some pharmacies located on the B.C. border are enrolled in BC PharmaCare. Although these border pharmacies cannot submit your claim for immediate online adjudication, they can submit a paper claim to PharmaCare on your behalf. Please check with the pharmacy before you fill your prescription.

Over-the-counter (OTC) medications and devices: Whether you purchase an OTC medication or a device at a B.C. pharmacy or an out-of-province pharmacy, it must be processed as a prescription. For out-of-province purchases, this means you will need an official prescription receipt that you can submit to PharmaCare for reimbursement.

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