The Provider Guide for Pharmacy Benefits contains information about the services and policies for NIHB beneficiaries and the Drug Benefits List contains drugs eligible for NIHB clients. Claims for NIHB patients are adjudicated through Express Scripts Canada for more information click here.

To be eligible under the NIHB Program, extemporaneous mixtures must have at least one ingredient listed on the Drug Benefits List and must not duplicate the formulation of commercially manufactured drug products. Mixtures that contain exception or ‘limited use’ drugs must receive prior approval by the NIHB Drug Exception Centre; those that contain ingredients excluded from the Program will not be eligible for coverage.

For more information, please contact the Provider Claims Processing Call Centre at 1-888-511-4666 to speak with an ESC Representative.

Biosimilar Transition

Effective March 4, 2025, NIHB Program’s Biosimilar Transition Policy, will apply to all provinces and territories. The biosimilar initiatives involves transitioning patients from originator biologic drugs to biosimilars listed on the provincial drug plan in order for the patient to maintain their coverage. Between March 4, 2025 and March 4, 2026, patients 19 years of age and older who use certain originator biologics (etanercept, infliximab, and rituximab) must transition to a biosimilar to maintain their coverage under the NIHB program. The originator biologic will no longer be covered by NIHB as of March 5, 2025 unless exceptional coverage is requested and approved.

See the announcements from NIHB here: NIHB_Pharmacy Bulletin_New Biosimilar Transition Policy_Rest of Canada_March 4_2025

Additional resources on biosimilars can be found on our webpage here: Biologic to a Biosimilar – Pharmacy Association of Saskatchewan

Medical Supplies and Equipment (MS&E) Claims Submission and Provider Payment Policies

Effective February 11, 2025, providers are required to submit Prior Approval requests and claim for payments in compliance with the MS&E Policies using the updated program forms. Within the announcement from NIHB are additional links to supporting materials on the policy, including informational videos for providers.

See the announcement from NIHB here: NIHB_MSE Bulletin_Claims Submission and Provider Payment Policies_In Effect_Feb. 11_2025

MS&E Claims Submission & Provider Payment Policies: 1.0 General policies

MS&E Submission Kit: NIHB

MS&E Price Files: NIHB