- BC signed a federal pharmacare deal worth over C$670 million over four years to deliver free public coverage for contraception, diabetes medicines and supplies, and menopausal hormone therapy starting March 2026.
- The plan builds on BC's existing free prescription contraception and expanded PharmaCare eligibility for key diabetes and cardiovascular drugs including empagliflozin, semaglutide, dapagliflozin, and apixaban.
- PharmaCare is also updating policies on prosthetic and orthotic device funding and prescribing, adding some generic benefits, discontinuing certain products, and resetting Fair PharmaCare deductibles based on 2024 net income.
- Patient advocates argue major gaps remain because BC still excludes 30+ essential medicines covered in other provinces, leaving some people facing high out-of-pocket costs without private insurance.
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The recently signed pharmacare agreement between British Columbia and the federal government marks a significant shift in public drug coverage policy. Under this agreement, starting in March 2026, BC residents will receive free public plan coverage for contraceptives, devices and supplies related to diabetes care, and hormone replacement therapy (HRT) for menopausal symptoms. The funding—C$670 million over four years—is intended to remove cost as a barrier for over 1.3 million people requiring contraception and nearly 550,000 with diabetes in the province.
This builds on prior BC policy moves. Since April 2023, BC has offered universal, free contraception; more recently, the criteria for coverage of drugs treating Type 2 diabetes have been relaxed—empagliflozin and semaglutide shifted from third-line to second-line treatments after metformin, and coverage was expanded for dapagliflozin and apixaban. These incremental steps laid groundwork for larger pharmacare investments.
Simultaneously, PharmaCare has made operational policy changes: prosthetic & orthotic (P&O) component funding is now pegged to the lowest-cost Canadian supplier (with fallback when none exists abroad), nurse practitioners are permitted to prescribe P&O device coverage, and a range of formulary updates have been enacted—some benefiting patients with generics, others withdrawing discontinued products like Levemir Penfill and certain epinephrine injectors. Annual Fair PharmaCare deductibles reset based on 2024 income.
While these expansions represent positive developments for equity and access, advocacy groups remain critical of gaps: BC PharmaCare does not cover some medications that are publicly funded in other provinces, including drugs for rare or severe conditions. Examples such as Revestive® (teduglutide) for short bowel syndrome highlight the excruciating trade-offs faced by patients, who may have to pay out-of-pocket or rely on manufacturer compassionate access. Funding per capita in BC for prescription medications is much lower than the national average, intensifying pressure for broader formulary reform.
Strategic implications: These changes may shift prescribing practices (for example, more frequent use of empagliflozin or semaglutide earlier in treatment), reduce financial hardship for key demographics (women, gender-diverse, people with diabetes), and place pressure on PharmaCare’s budget and supply chain, especially with inflation and drug cost volatility. Long-term, gaps in coverage of some drugs risk political and legal challenges, especially under equity and right-to-health frameworks. It also sets BC as a sectoral leader in leveraging biosimilars and cost containment to expand universal coverage.
Open questions:
- What medicines remain excluded and what is the timeline or process for adding them to benefits?
- How will cost pressures affect premiums, deductibles, or overall sustainability of the pharmacare expansions?
- What operational challenges (e.g. in supply, prescribing authority, specialty care) will arise when implementation begins in March 2026?
- How will BC’s experiences influence pharmacare policy and funding in other provinces and at the national level?
Supporting Notes
- The BC-Canada pharmacare agreement provides over C$670 million over four years to fund free public coverage of contraception, diabetes medications, devices and supplies, and hormone replacement therapy; benefitting over 1.3 million for contraception, ~550,000 with diabetes. Coverage begins March 2026.
- Since April 2023, BC has offered universal free prescription contraception, with more than 306,000 people having benefited by 2024.
- Drugs dapagliflozin (Forxiga) and generics of apixaban were expanded from limited to regular benefits starting January 5, 2023; empagliflozin (Jardiance) and semaglutide (Ozempic) had their eligibility criteria relaxed (from third-line to second-line after metformin).
- PharmaCare’s policy change effective January 1, 2026: covering P&O component costs up to the lowest-price Canadian supplier equivalent; NP prescriptions accepted for P&O device coverage; product discontinuations (Levemir Penfill, certain epinephrine injectors); annual deductible reset.
- In 2022, BC’s funding per person for prescription medications was C$257 compared to the Canadian average C$442.
- BC PharmaCare has denied over 30 essential medications approved elsewhere, including Revestive® (teduglutide), leaving patients with rare diseases without access unless through private insurance or manufacturer programs.
- BC’s biosimilars initiative has saved approximately C$732 million since 2019 by switching people from reference biologics to biosimilars; over 40,000 patients in BC have switched.