The Non-Insured Health Benefits Client Safety Program (NIHB-CSP)

What is the NIHB Client Safety Program?

Clients enrolled in the NIHB-CSP are restricted to a sole prescriber for opioid, benzodiazepine, stimulant, gabapentin-pregabalin and/or nabilone prescriptions (i.e. restricted medications). The NIHB-CSP aims to reduce client safety risks associated with problematic use of restricted medications.

Which clients are enrolled in the NIHB-CSP?

Clients are enrolled in the NIHB-CSP based on their patterns of prescription drug use. Additionally, clients treated for opioid use disorder with methadone, buprenorphine/naloxone (Suboxone and generics), long acting morphine (Kadian) or others are enrolled.

What happens when your patient is enrolled in the NIHB-CSP?

The client is asked to choose a sole prescriber who will be responsible for writing all their prescriptions for restricted medications. These medications will not be covered by NIHB until they choose a sole prescriber.

This prescriber may agree to be the sole prescriber for one or more of these four classes of drugs.

Note: NIHB coverage for other medications your patient may be taking is not affected.

How does the NIHB-CSP reduce client safety risks?

The NIHB-CSP helps to ensure the sole prescriber is aware of ALL restricted medications covered by the NIHB Program. The prescriber can then work with the client to assess the appropriateness of treatment.

What will happen at the pharmacy?

Once the client has been enrolled in the NIHB-CSP, NIHB will reject claims for the restricted medications. In order to process the claim, the pharmacy must call the NIHB Drug Exception Centre (DEC). DEC will fax the pharmacy a NIHB-CSP package to give to the client.

The pharmacy will be paid a usual and customary dispensing fee for providing the NIHB-CSP package to the client. The pharmacist will be issued a Prior Approval for pseudo-DIN 91500001 in order to claim the fee.

What happens after the client has been given the NIHB-CSP package?

Until the NIHB Program receives a signed Prescriber Acceptance Form, claims submitted for restricted medications will be rejected at point of sale. The Drug Exception Centre may authorize a one-time 7-day supply of the medication in order for the client to find a sole prescriber.

What does this mean for the prescriber?

If the prescriber agrees to be the sole prescriber for one or more restricted medications, they need to sign and fax the Prescriber Acceptance Form to NIHB. Once received, NIHB will resume coverage of prescriptions for benzodiazepines, opioids, stimulants, gabapentin-pregabalin and/or nabilone.

For more information, call the Drug Exception Centre.