12/04/2025
Non-Insured Health Benefits Updates for December 2025
💊Pharmacy benefit information
New pharmacy benefit listings
Refer to the Drug Benefit List to find all eligible products and criteria for coverage.
📌The following medications and products are now covered as open benefits without prior approval:
Vemlidy (tenofovir alafenamide) for the treatment of chronic hepatitis B in adults
📍The following listings are covered as limited use benefits with prior approval:
Praluent (alirocumab) pre-filled pens previously listed at 75mg/ml and 150mg/ml, now available in 300mg/2ml pre-filled pens, for the treatment of adult patients with high cholesterol
Venclexta (venetoclax) for the treatment of chronic lymphocytic leukemia (CLL)
Omlyclo (omalizumab) for the treatment of severe asthma caused by an allergy
Fruzaqla (fruquintinib) for the treatment of metastatic colorectal cancer
Evkeeza (evinacumab) for the treatment of adult and pediatric patients aged 5 years and older with very high cholesterol
Bylvay (odevixibat) for the treatment of severe itching in patients with progressive familial intrahepatic cholestasis, a condition affecting the liver
Ultomiris (ravulizumab) for the treatment of certain conditions affecting the nerves
📢Addition of Humira and Humira Citrate free to the biosimilar transition policy
Under the NIHB Biosimilar Transition Policy, clients 19 years of age and older who are taking certain medications are required to transition to the biosimilar version of their medication in order to maintain coverage
This policy aligns with other provincial and territorial drug plans and helps support consistent client access to medications and care
Adalimumab (Humira and Humira Citrate free) is now included under this policy, in addition to Enbrel, Remicade and Rituxan
Clients who are currently taking Humira and Humira Citrate free have until May 25, 2026 to transition to a biosimilar version of their medication in order to maintain coverage
Make an appointment to speak with your health care provider if this change applies to you. Pharmacists and prescribers are well informed about biosimilars and have already helped many people transition to these medications
Consult the Health Canada website for more information on biosimilar biologic drugs
👩🦽Medical supplies and equipment benefit information
New coverage for enteral EnFit feeding syringes
NIHB now provides coverage for two new Enfit feeding syringe sizes: 3 cc/mL, and 20 cc/mL
More information can be found in section 9.0 Self-care of the NIHB Medical Supplies and Equipment Guide and Benefit lists
❤️Addition of mental health counsellors as recommenders of gender Identity Items
NIHB now accepts mental health counsellors recognized by the program as eligible medical supplies and equipment recommenders for gender identity items, where allowed under their provincial and territorial scope of practice
For more information on provider eligibility in your province or territory, please refer to section 9.0 Self-care of the NIHB Medical Supplies and Equipment Guide and Benefit Lists
