FAQs about medication coverage for refugees and refugee claimants
Why do I need to know what coverage my patient has?
Knowing what services are covered for your newcomer patients (e.g., lab work, nursing care, diagnostic testing, dental, eye care) is important. Knowing whether a medication you prescribe will be covered for your patient can avoid issues with fulfillment at the pharmacy and reduce the likelihood of your patient not taking their medication because it is difficult or expensive to obtain.
How do I know what coverage my patient has?
The Interim Federal Health Program (IFHP) provides limited, temporary, publicly funded coverage of health care benefits for refugees, refugee claimants and certain other eligible individuals in Canada, based on their immigration status. More information about the IFHP is available in this resource, including eligibility criteria for refugees and refugee claimants.
Once approved for coverage, the patient receives an IFHP eligibility document from Citizenship and Immigration Canada (CIC) or the Canada Border Service Agency (CBSA). This eligibility document can be either:
- a Refugee Protection Claimant Document (with photo), or
- an IFHP Certificate (without photo). When your patient has an IFHP Certificate, they also need to present a document with government- issued photo identification (ID) to the pharmacy.
The pharmacy requires an IFHP eligibility document because it includes billing information for medication.
While either version of the IFHP document shows the patient’s coverage type and duration of coverage at the time it was issued, it does not prove that the patient still has the same IFHP coverage on the day of their visit to the pharmacy. Changes to the patient’s immigration status can affect coverage, and although newcomers are notified of changes to their immigration status, their IFHP coverage can be cancelled or modified in CIC’s system without an updated document being issued.
Therefore, it is important to verify a patient’s IFHP coverage with the IFHP Claims Administrator, Medavie Blue Cross (Medavie), at each visit, before providing medical services or a prescription for medication. You can verify your patient’s coverage by:
- Calling the Medavie Contact Centre at their toll-free number: 1-888-614-1880, or
- Logging into the IFHP Secure Provider Web Portal.
Note that it takes at least 2 business days for new coverage to be active in Medavie’s system after it is issued.
Keep up-to-date with IFHP rules and regulations for refugees and refugee claimants. Changes to this program affect coverage and processes. Current information about the IFHP is available from Citizenship and Immigration Canada.
What if my patient doesn’t have the proper forms with them or their coverage has expired?
The IFHP will not reimburse pharmacies for claims made if the patient’s coverage has expired. Ask the patient or case worker to reapply, online or by mail, to their local CIC office to obtain the proper documents or renew their coverage. The information needed to apply for coverage is available from Citizenship and Immigration Canada's page about the IFHP.
What does the IFHP cover?
The IFHP has 3 different categories of coverage. The following provide coverage only if the person is NOT eligible for health care benefits payable under provincial/territorial or private health insurance plans.
- Expanded Health Care Coverage
- Health Care coverage
- Public Health or Public Safety Health Care Coverage
Ask patients if they are eligible for provincial or territorial health care insurance or if they have private health insurance that may cover a prescription. When a prescription is covered under another insurance plan, it will not be reimbursed by the IFHP. Also, the IFHP does not cover additional costs that are covered by another plan, and does not provide “top-up” coverage. Benefit grids and a drug formulary for these three categories of coverage are available from Medavie Blue Cross.
How do these categories differ?
- Expanded Health Care Coverage (EHCC) includes expanded medical and diagnostic care, plus supplemental benefits, including medications and vaccines. Physicians and pharmacists can expect a level of medication coverage similar to their provincial/territorial formulary or social assistance plan (for example, the Ontario Drug Benefit formulary in Ontario). However, it is important to check the IFHP’s Expanded Drug Benefit List. If the medication is not on this list, it will not be covered. Provincial/territorial formularies may list some medications as restricted access only (i.e., Exceptional Access, Restricted Use or Limited Use). These medications are usually covered by the IFHP provided that prior authorization by the plan is obtained.
- Health Care Coverage (HCC) provides medical, hospital and diagnostic care in response to a medical emergency or for assessment and follow-up of a specific illness, symptom, complaint or injury, including prenatal care, labour and delivery. This coverage is similar to that provided by provincial/territorial health care plans. However, it ONLY covers medications and vaccines needed to prevent or treat a disease or condition that poses a risk to public health or public safety. Such products are listed in the IFHP Public Health and Public Safety Drug Benefit List.
- Public Health or Public Safety Health Care Coverage (PHPSHCC) includes medical, hospital and diagnostic care to diagnose, prevent or treat a disease that poses a risk to public health or a condition of public safety concern. Note that its provisions also cover examinations and diagnostic services to confirm or rule out such a diagnosis. Similar to Health Care Coverage, it ONLY covers medications and vaccines needed to prevent or treat a disease posing a risk to public health or a condition of public safety concern. These products are listed in the IFHP Public Health and Public Safety Drug Benefit List.
Consult the drug benefit lists on the IFHP Provider Website to make sure the medication you want to prescribe is covered.
What do pharmacies need to know?
There is a useful online handbook on medication coverage for the IFHP, current formularies, claim procedures and plan updates.
The pharmacist billing for a prescribed medication must check the patient’s IFHP document, which contains numbers allowing them to bill for the medication. When contacting the IFHP Claims Administrator, the pharmacist will need:
- The patient’s 8-digit immigration client ID number
- The patient’s name, sex and date of birth
- The benefit code, if applicable
- The provider number
- When the patient is covered under the IFHP Health Care Coverage (HCC) or Public Health or Public Safety Health Care Coverage (PHPSHCC), the patient’s diagnosis or prescriber’s contact information is also needed to confirm the condition being treated.
- Government-issued photo ID
Pharmacies can submit their claims either electronically or using paper claim forms. Paper claims can be sent by fax to 506-867-3824 or mailed to:Interim Federal Health ProgramMedavie Blue Cross644 Main St. PO Box 6000Moncton, NB E1C 0P9
The Medavie Contact Centre can answer inquiries from health care providers on eligibility, benefits and claim form requests, and is available from 8:30 to 4:30, Monday to Friday. The IFHP secure provider web portal can also be used to confirm client and benefit eligibility, and to submit prior approval requests and claim forms.
If patients have questions regarding their eligibility for the IFHP itself, they should contact the CIC Call Center at 1-888-242‑2100.
Note: When there is a cost difference between what is covered by the IFHP and what the pharmacy has billed, the pharmacy CANNOT charge the patient for the difference.
How does prior approval work for medication?
Prior approval is required for all medications filled under the Health Care Coverage or Public Health or Public Safety Health Care Coverage. Prior approval is also required for medications on the formulary that are considered to be for limited use, special authorization or exceptional use according to the provincial/territorial formulary.
For patients with HCC or PHPSHCC, only medications needed to prevent or treat diseases that pose a risk to the public and listed in the IFHP Public Health and Public Safety Drug Benefit List will be covered.
Special authorization requests can be submitted electronically, by phone,or by using a paper form, to Medavie Blue Cross. If by phone, the call will be directed to a nurse in the special authorization unit.
Picto Rx: The Children's Hospital of Eastern Ontario's pharmacy department has developed Picto Rx, software which can translate medication information into Arabic and other languages. The Picto Rx pictograms provide a means of communicating medication instructions when there is no common language. The software helps pharmacists to build visual instructions, information sheets and medication calendars for their patients. Picto Rx is free to download for any pharmacist around the world via the International Pharmaceutical Federation's (FIP) website.
- Amanda Blazevic, BScPharm
Last updated: April, 2018