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Insurance & Coverage – General Overview

What’s covered by private insurance, provincial health plans, or NIHB?

Monica avatar
Written by Monica
Updated yesterday

Medication coverage can vary significantly based on your province of residence, insurance provider, and the specific terms of your benefits plan.

Our partner pharmacy will submit claims directly to your insurance or benefits provider; however, please note that pre-adjudication is not available. This means we are unable to confirm your exact coverage amount prior to processing your first fill.

Once your prescription has been processed, any remaining out-of-pocket costs will be charged to your credit card. You will also receive an email with a detailed cost breakdown.

📌 If you have private insurance or a provincial health card, please ensure this information is uploaded under the Billing & Shipping tab of your account to facilitate accurate billing.

Below is an overview of the different types of coverage that may apply.


🏥 Private Insurance

If you have private or workplace insurance:

  • Contact your insurer with the medication name and DIN to check eligibility

  • Our partner pharmacy will bill the insurance we have on file for any potential coverage

🧠 Note: Practitioner visits are not typically covered by private insurance.


🍁 Provincial Drug Plans

Ontario Drug Benefit (ODB)

Eligibility depends on the program you’re enrolled in and whether your medication is listed on the ODB Formulary.

ODB includes:

  • OHIP+ (under 25 without private insurance)

  • ODSP (disability support)

  • Ontario Works (financial assistance)

British Columbia – PharmaCare

  • Register for Fair PharmaCare

  • Check PharmaCare Special Authority for more information

  • Upload both sides of your BC Services Card (PHN) under the Billing and Shipping tab

  • Coverage applies automatically if the medication qualifies

For more information on birth control coverage through PharmaCare, please see this article: Insurance & Birth Control Coverage

Other Provincial Health Plan Coverage:

For more details on provincial health plan coverage, see below:

  • Alberta: Learn more about AHCIP here. Search for covered drugs here.

  • British Columbia: Learn more about PharmaCare here. Search for covered drugs here.

  • Manitoba: Learn more about MEPP (effective April 15, 2025) here. Search for covered drugs here.

  • Nova Scotia: Learn more about MSI here. Search for covered drugs here.

  • Ontario: Learn more about OHIP+ here. Search for covered drugs here.

  • Prince Edward Island: Learn more about Health PEI here. Search for covered drugs here.

Currently, our partner pharmacies are located in Ontario and British Columbia, so we’re unable to bill other provincial plans directly.

To ensure coverage, we recommend sending your Felix prescription to a local pharmacy. You can do this at checkout by selecting “Pickup at external pharmacy” under your shipping address, then entering your local pharmacy’s name and fax number.


🧾 NIHB (First Nations & Inuit)

The Non-Insured Health Benefits (NIHB) program provides prescription drug coverage for eligible patients who are:

  • Registered under the Indian Act, or

  • An Inuk recognized by a land claim organization
    See full eligibility

Felix Pharmacy can bill NIHB directly. Just upload:

  • Your status card or NIHB number to the front section of your Billing information

  • Your private insurance card, if applicable, to the back section of your Billing information— NIHB will act as secondary coverage

Review the NIHB Drug Benefit List for eligible medications.


⚠️ Why Was I Charged the Full Amount?

Even with insurance uploaded, you may be charged the full amount if:

  • Special authorization is required (common for weight loss medications)

  • You have requested an early refill

  • You’ve reached your plan's maximum limit

  • The medication is compounded (does not include a Drug Identification Number)
    → In that case, your shipment includes a receipt for submitting a manual claim.


✅ What To Do:

  • Review your plan details using the resources linked above to better understand your coverage

  • Upload all insurance and health plan info to your the Billing and Shipping tab of your account

  • Reach out to our team anytime via chat within your account of at felixforyou.ca/contact

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