Indigenous and Northern Affairs committee  According to the people on the phone, it's out of their hands. They don't know. They can't do anything about it. If something's not approved, it's not approved. We can try to appeal it, but it goes to people and then it goes to other people, you know. Then it comes back as “decli

Indigenous and Northern Affairs committee  Absolutely.

Indigenous and Northern Affairs committee  I don't know the mechanism, but we send a fax to the NIHB for approval. Sometimes we follow-up three or four days later and say that we sent an approval and ask if there is any response. They say they didn't get it. Well, I know I sent it and I have confirmation that it was sent,

Indigenous and Northern Affairs committee  Yes, but that is probably a system that has to be integrated between the departments, ESI, the doctors' offices, the NIHB call centres and the pharmacies. Yes, there's Internet, but which system has to integrate within the others? It's a process. That's an IT issue that I don't k

Indigenous and Northern Affairs committee  I believe it's two weeks.

Indigenous and Northern Affairs committee  It definitely has, but what has happened is that it's not the delay. It's the decline or the nonpayment. If I can, I'll give a quick example. A patient has an ostomy. An ostomy is an opening in their abdomen. They've had cancer and the removal of part of their colon, let's say,

Indigenous and Northern Affairs committee  Sometimes that does happen. Yes, that is correct.

Indigenous and Northern Affairs committee  It's very damaging to the patient, first off, because they leave. They can be frustrated. Some people can fight on their behalf and go speak to the doctor or go to the health centre, but some other patients are vulnerable. If they have a mental health issue or if they have, let's

Indigenous and Northern Affairs committee  It's mental health, absolutely, and addiction.

Indigenous and Northern Affairs committee  We need follow-ups. People get diagnosed, and then they don't get the follow-ups, counselling, the cognitive behavioural therapy and the psychotherapy. It's not just medication. They need counselling and follow-ups constantly.

Indigenous and Northern Affairs committee  Thank you for the question. I do not think so. No. Can I explain just briefly how the process of calling a helpline works?

Indigenous and Northern Affairs committee  The prescription comes from the doctor. We try to process it. It says, “special authorization required”. We call ESI, Express Scripts, Inc., which adjudicates on behalf of NIHB. We apply for the prior approval. NIHB sends the approval to the doctor. The doctor has to fill it out

Indigenous and Northern Affairs committee  That might help a little bit, yes, but at the end of the day, it has to go to the prescriber who has actually written the prescription to fill out the paperwork and say whether the patient fits the criteria for that medication.

Indigenous and Northern Affairs committee  I believe that medications that need prior approval should be like the provincial plan, where there's something called “limited use”, a sheet of paper that we send directly from the pharmacy to the doctor. The doctor signs it and sends it back. If we have that documentation, we'r

Indigenous and Northern Affairs committee  Not to my knowledge, no. As I mentioned in that opening statement, a lot of pharmacies do not know how to deal with and provide service to NIHB clients. Because of the number of different departments and phone numbers, they don't know what to do. Sometimes they just say, we don'