Canada Pharmacare & Prescription Drug Coverage: What You Should Know in 2025

Understand Canada’s new pharmacare law, provincial drug plans, costs, and how to access coverage — clear, up-to-date guide for 2025 and beyond.

Prescription drugs can be lifesaving, but even in Canada many people worry about how to pay for them. With rising drug costs and patchy coverage across provinces, the question “Who pays for my medicine?” is all too real. The federal government has now passed landmark pharmacare legislation, but the system is complex. In this article, I’ll walk you through how prescription drug coverage works in Canada today, what’s changing, and what it means for you.

By the end you’ll understand:

• How provincial and private drug plans currently work
• What the new national pharmacare law (Bill C-64) does
• How coverage differs across provinces
• What your costs might be and how to enroll
• Trade-offs, risks, and how to plan ahead

Let’s begin.

Canada’s Current Prescription Drug Landscape

Medicare in Canada: What It Covers — and What It Doesn’t

Canada’s universal health care system, often called “Medicare,” ensures that medically necessary hospital and physician services are publicly covered. But prescription drugs are not universally included. Outside of hospital settings, drug coverage is handled by a mix of provincial programs, private insurance, and out-of-pocket payments.

That means even though you may not pay for a doctor visit, you often do pay when picking up your medication. The result: many Canadians face financial burden or skip doses because of cost.

The Patchwork of Provincial / Territorial Drug Plans

Every province and territory in Canada runs its own public drug plan (or plans), but their rules vary widely: who is eligible, which drugs are covered, and how much the patient pays. Below is a summarized breakdown of how these plans work:

These provincial plans are constrained by formularies (lists of drugs covered), tiered cost structures, and “exceptional access” procedures for non-listed medications.

A useful resource is the CIHI Pharmaceutical Data Tool, which lets users compare publicly funded drug program spending and designs across jurisdictions in Canada.
You can explore it here: CIHI Pharmaceutical Data Tool to see how much each province spends and what they cover.

Meanwhile, the Canadian Institute for Health Information’s NPDUIS (National Prescription Drug Utilization Information System) consolidates claims and formulary data for public drug programs across provinces and territories. This gives policy makers and researchers insight into usage patterns, cost pressures, and gaps in coverage.

According to NPDUIS metadata, it currently holds data from 10 provinces and territories for public drug plans, making it a primary source of pan-Canadian prescription drug statistics.
(For more about NPDUIS, see the Government of Canada’s NPDUIS overview.)

Because of this patchwork, many Canadians have to piece together coverage: relying partly on public plans, partly on employer or private insurance, and partly paying out of pocket.

Private Insurance and Out-of-Pocket Spending

Private drug insurance (often provided via an employer or union) plays a big role. But these plans come with limits: formularies that exclude some drugs, partial reimbursement, copays, deductibles, or maximum payouts.

A recent report on private drug plans from 2018–2023 shows strong cost growth: in 2023, private drug plan expenditures rose significantly (total prescription costs up 12.9% over prior year).
This shows the pressure drug costs place even on insured populations.

What this means in practice:

• You may have coverage for “generic” drugs but not newer brand-name or specialty medicines
• You could hit benefit caps and then pay fully out of pocket
• Private plans may exert controls such as prior authorization, tiered formularies, or preferred drug lists

Because of these limits, many Canadians still face high out-of-pocket spending, or even forgo medications they need.

As a result, debates over “pharmacare” — a national approach to prescription drug coverage — have grown louder.

The New National Pharmacare Initiative

What Is Bill C-64 (the Pharmacare Act)?

In February 2024, the federal government introduced Bill C-64, also known as the the Pharmacare Act. The goal: to set a legal framework for a national drug coverage program across Canada.

• The Act mandates the development of a national formulary (a core list of essential drugs) and a bulk purchasing strategy to negotiate better prices.
• It authorizes federal payments to provinces and territories that enter into bilateral agreements to provide “first-dollar” (i.e. no out-of-pocket) coverage for selected prescription drugs and related products.
• It also requires the establishment of a committee of experts, as well as a pan-Canadian strategy for the “appropriate use” of prescription medicines.

The Act passed into law via Royal Assent on October 10, 2024. With that, Canada laid the legal foundation for national pharmacare, although implementation depends heavily on cooperation from provinces and territories.

Phase 1: What Drugs Are Covered (So Far)

Because drug coverage in Canada is so complex, the government chose a phased approach. The first phase focuses on contraception and diabetes — both high-impact areas with major equity and public health implications.

Here’s what we know:

• Contraceptive coverage: Under the new agreements, eligible Canadians will have free access to a wide range of contraceptive options, including oral contraceptives, copper and hormonal IUDs, rings, implants, and injections.
• Diabetes medications and supplies: Commonly used drugs like metformin, various insulin products, sulfonylureas, and SGLT-2 inhibitors are in scope. Also included is coverage for devices and supplies such as glucose monitors, test strips, syringes, and insulin pumps.
• The idea is “first-dollar” coverage: patients won’t pay copays or deductibles for these medications under bilateral provincial agreements.

However, this doesn’t mean all diabetes or contraceptive drugs are covered yet; inclusion depends on negotiations and provincial formulary decisions.

Where Provinces Stand: Agreements and Gaps

To make Phase 1 a reality, individual provinces must sign bilateral deals with the federal government. Some provinces have moved faster than others.

• Manitoba: As of April 2025, Manitoba signed the first formal agreement and launched the Manitoba Enhanced Pharmacare Program (MEPP). Under MEPP, eligible residents get no-cost coverage for birth control, diabetes drugs, HIV treatments, and hormone therapy.
• Other provinces: A few have announced intent or preliminary agreements. British Columbia was among the first to express support and is actively engaging.
• Holdouts and dissent: Some provinces, including Quebec and Alberta, have expressed resistance or hesitancy regarding full participation. They cite concerns over cost, provincial autonomy, and integration with existing plans.

Because health care (including drug coverage) is constitutionally a provincial responsibility, the federal government can’t unilaterally impose pharmacare. It must negotiate cooperation.

Challenges & Limits in the New Law

While Bill C-64 is a breakthrough, it doesn’t guarantee universal drug coverage overnight. Some limitations and concerns:

• Limited drug scope (initially): Only a subset of medications is included in Phase 1; many drugs—especially newer specialty or biologic medications—are excluded for now.
• Provincial opt-out risk: A province could choose not to sign an agreement or delay implementation, leaving residents with uneven access.
• Funding sustainability: The program will require sustained federal transfers, and cost overruns or inflationary drug pressures could strain budgets. Some critics argue the law lacks clear guardrails for long-term financing.
• Implementation logistics: Integrating provincial drug plans, updating IT systems, ensuring pharmacies are ready, and managing “exception drug status” requests all present operational hurdles.

Some experts view C-64 more as a framework law than a final, complete program. It establishes the principles and tools, but many details remain for future regulation or negotiation.

Province-by-Province Drug Coverage (as of 2025)

Canada’s provinces and territories each run their own public drug plans. Some have already moved to adopt parts of the new national pharmacare program; others remain largely unchanged. Below is a snapshot of key provinces and their plans, with notes on how they are—or aren’t—aligning with national pharmacare.

British Columbia (BC)

BC’s drug plan is one of the more comprehensive and progressive among provinces.

• Residents enroll in PharmaCare, which includes Fair PharmaCare — an income-based plan that helps families pay for eligible prescriptions.
• Some contraceptives and other medications are already fully covered under Plan Z, Plan C, Plan G, or Plan W, meaning no out-of-pocket at dispensing for those categories.
• PharmaCare covers not only drugs, but also devices (such as diabetes supplies), pharmacy services (like medication reviews), and some minor ailment prescribing.
• Drugs not covered by the standard formulary may require a Special Authority application by the prescriber.
• Importantly, in March 2025, BC signed a bilateral pharmacare agreement with the federal government. Under that deal, BC will receive over $670 million over four years to expand coverage for contraceptives, diabetes medications, and supplies, with implementation of universal access anticipated starting in March 2026.

Let me summarize in a mini table:

Because BC is among the first to formalize an agreement, residents there are positioned to benefit early from national pharmacare’s Phase 1.

Ontario

Ontario’s drug coverage is more limited for the general population, focused on targeted groups:

• Ontario Drug Benefit (ODB) covers seniors (65+), residents in long-term care, people on social assistance, and others in special categories.
• Trillium Drug Program assists individuals and families who face high drug costs relative to their income.
• Many working-age adults without chronic disease or without access to private insurance receive no provincial coverage.
• As of yet, Ontario has not fully signed on to the national pharmacare Phase 1 agreement (publicly announced), so uptake will depend on future negotiations.

Quebec

Quebec’s system is somewhat unique:

• Under RAMQ’s Public Prescription Drug Insurance, all residents must have drug insurance. If your employer offers a private plan, you must generally join it; if not, you enroll in the public plan.
• The public plan covers over 8,000 medications, based on an official list (formulary).
• Quebec has resisted full integration into the national pharmacare framework, citing the strength and autonomy of its hybrid (public + mandatory private) model. Some analyses note that Quebec has expressed hesitation about fully joining the federal scheme.

Other Provinces & Territories (Snapshot)

• Manitoba: Already signed a pharmacare agreement and launched the Manitoba Enhanced Pharmacare Program (MEPP). The agreement covers contraception, diabetes drugs, hormone therapy, and HIV treatments.
• Saskatchewan, Alberta, New Brunswick, Nova Scotia, Newfoundland & Labrador, PEI, and the territories: each has public drug or pharmaceutical benefit programs, often targeted to seniors, low-income residents, or particular disease groups. (Health Canada provides a list of provincial public drug benefit programs by jurisdiction.)
• Some of these jurisdictions have begun negotiations or expressed intent to join national pharmacare, while others remain cautious or noncommittal.

First Nations, Inuit, and Federal Drug Benefit Programs

Finally, a word on federally administered programs:

• The Non-Insured Health Benefits (NIHB) program provides drug coverage to eligible First Nations and Inuit populations.
• Some federal programs also cover veterans, federal inmates, and other groups outside provincial jurisdiction.

These federal programs often operate independently of provincial plans and will need alignment to fully mesh with a national pharmacare system.

How Coverage Works, What You Pay, and How to Enroll

Understanding how drug coverage actually works in practice will help you see whether you might benefit — or where gaps may remain.

Cost Structure: Copays, Deductibles, and First-Dollar Coverage

Public drug plans typically use cost-sharing: a combination of deductibles, copayments, or coinsurance. You often need to pay out of pocket until you hit a deductible, and then the plan pays a share. Some plans cap the maximum amount you’ll pay in a year.

Under national pharmacare Phase 1 (Bill C-64), the goal is first-dollar coverage—meaning no deductible or copay—at least for the core list of contraception and diabetes drugs in provinces that have signed agreements. The federal government emphasizes this in its announcement of the pharmacare law.
You can read more in Health Canada’s summary of the legislation.

But remember: first-dollar coverage applies only to those medicines covered under the bilateral agreements. For other drugs, typical cost sharing still applies.

Also, cost to the plan will include not just the drug itself, but dispensing fees, pharmacy markups, and sometimes prescriber or delivery fees, depending on the jurisdiction.

Different Populations: Seniors, Low Income, Chronic Disease

Coverage—and costs—vary significantly depending on who you are:

• Seniors often qualify automatically for public plans (or enhanced coverage) in many provinces.
• Low-income individuals and families may qualify for income-based assistance so their deductibles or copays are reduced or waived.
• People with chronic diseases or high medication needs may access “special drug plans” or high-cost drug programs with lower cost sharing or expedited access pathways.
• General adult population with no chronic condition may face the least favorable terms: fewer options, higher out-of-pocket, or dependence on private insurance.

The national pharmacare framework aims to reduce those disparities, especially for the covered drug categories, but full equalization will take time.

How to Enroll or Access the Plan

To get coverage under your provincial drug plan—or the national pharmacare portion—you’ll typically need to do the following:

1. Check whether your province or territory has signed the pharmacare agreement
   Health Canada provides a list of provinces and territories that have bilateral agreements in place. If your province is listed, you should be eligible for the covered drugs at no cost in your pharmacy.
   See “How to access national pharmacare” on Canada.ca.
2. Ensure your public drug plan registration is up to date
   Many provinces require you to enroll or reauthorize coverage each year. For example, in British Columbia you need to have your Fair PharmaCare registration and income verification active.
3. Present a valid prescription at a participating pharmacy
   For the drugs covered under the pharmacare agreement (contraception, diabetes), you should be able to pick them up at fully subsidized cost (in provinces in agreement).
4. Submit additional documentation if required
   Some drugs (non-listed, specialty) may require a “special authorization” or “exception” request by your doctor.
5. Monitor transitions carefully
   If your province is newly adopting pharmacare, there may be transition periods, grandfathering of existing prescriptions, or delays. Always check announcements from your provincial health ministry.

If your province has not yet signed an agreement, you’ll continue using existing public, private, or out-of-pocket coverage. In such cases, explore whether your drugs might eventually be covered under future phases.

Exclusions & Exceptional Access

Even within provinces that adopt pharmacare coverage, not every drug will be included:

• New, high-cost specialty drugs (e.g. many biologics, oncology drugs) are often excluded initially.
• Drugs outside the core list (beyond contraception or diabetes) will require negotiating between federal and provincial formularies.
• Some coverage policies include “exception status” pathways, where a prescriber argues a case for coverage based on medical necessity.

In short: for drugs outside the covered list, your usual private insurance or public plan rules still apply.

Benefits, Risks & Critiques

Any national pharmacare program offers promise—but also faces real challenges. It’s important to view both sides.

Expected Benefits

1. Greater equity in access
   Many Canadians currently skip or delay medications because of cost. A national pharmacare program can reduce that hardship—especially for people with lower incomes or chronic conditions. Proponents argue it makes access fairer across provinces.
   (See analysis in Canada’s national pharmacare plan – boon or bane)
2. Lower overall drug costs through bargaining power
   A pan-Canadian purchaser negotiating bulk discounts could bring down prices. Having one standardized formulary reduces duplication and raises negotiating leverage.
   Resource: cost driver breakdowns from NPDUIS and Public-Private plan comparisons
3. Reduced administrative waste
   Instead of separate formularies, variable rules across provinces, and multiple insurance claims, a coordinated system cuts duplication and complexity.
4. Financial protection for households
   By covering more drugs with fewer copays or deductibles (especially for the covered classes), families are less likely to face catastrophic drug costs.
5. Better data & monitoring of drug use
   The new framework pushes toward more harmonized data systems (via CIHI’s NPDUIS and the proposed Canadian Drug Agency) which can improve decision-making and health outcomes.

Risks, Criticisms & Challenges

1. Sustainability and fiscal burden
   National pharmacare will add large new government expenditure. Some critics argue the federal government hasn’t clearly communicated the full cost, and that growth in drug spending (especially on high-cost drugs) could outpace budgets.
   (See commentary from the Fraser Institute)
2. Limited drug list initially
   The first phase focuses only on contraceptives and many diabetes drugs. New or costly drugs (e.g. advanced biologics) may be excluded, leaving gaps. Some critics worry the formulary is too narrow.
   Some medical professionals point out that legislation (Bill C-64) does not guarantee universal public coverage of even those drug classes.
3. Provincial opt-out or delays
   Because health care is provincial jurisdiction, provinces can decline to implement or delay agreements. That would leave citizens in those provinces with slower or lesser benefit.
4. Access delays or rationing
   To control costs, decision makers might delay approval of expensive or novel drugs, making it harder for patients needing them.
5. Pushback from private insurance, industry, stakeholders
   Private insurers may resist losing their role, pharmaceutical firms may resist price pressure, and provinces may protect their current drug systems. Some research recommends hybrid models (public + private coordination) instead of a pure single-payer system.
6. Implementation complexity
   Transitioning multiple provincial formularies and systems into a cohesive national scheme requires IT upgrades, regulatory alignment, and detailed stakeholder negotiation. Delays or mismatches could lead to service gaps.

What Evidence & Modeling Say (So Far)

• The Prescribed Drug Spending in Canada reports show public drug program spending reached $17.2 billion in 2022, with biologic drugs accounting for nearly 30% of that.
  This shows drug spending already pushes budgets even before pharmacare expansion.
• Cost driver analysis reveals that high-cost drugs (those > $10,000 per year) now represent a large share of public plan costs.
  Their growth rates are among the biggest pressures on sustainability.
• Projections for a full national pharmacare covering a “comprehensive list” suggest incremental annual costs could reach $15 billion or more by the late 2020s.
• Some studies argue that past attempts at universal drug plans in Canada (e.g. in Saskatchewan) were challenged by cost overruns, illustrating that scale and cost control are delicate.

In sum: evidence supports that pharmacare can help with equity and negotiation, but cost control, drug inclusion decisions, and provincial cooperation are major levers that will determine success.

What This Means for You (Practical Takeaways)

Knowing how these systems work can help you make better decisions. Here’s what you should do now and keep in mind.

Check if Your Province Has Signed On

• Before relying on national pharmacare coverage, verify whether your province or territory has signed a bilateral agreement with the federal government. Health Canada maintains a rollout status page under its “About Pharmacare” portal.
• If your province is participating, the covered drugs (e.g. contraception, diabetes medicines) should become available with no out-of-pocket cost under first-dollar coverage.
• If your province has not yet joined, nothing changes for now—you still rely on existing public or private drug plans, or pay out of pocket for uncovered meds.

Review Your Current Drug Plan & Coverage

• Compare your current provincial plan, employer / private plan, and the new national coverage. You may still need your private plan for drugs outside the subsidized list.
• If your drugs are included in Phase 1, you may save on copayments or deductibles.
• Watch for transition notices: even after signing, there may be phased implementation or grandfathering of existing prescriptions.

Plan for Future Drugs / Special Cases

• For very expensive or specialty medications (e.g. biologics, rare disease treatments), coverage may continue under existing or exceptional access policies.
• If you have a chronic condition, talk with your doctor about whether your medications are likely to be added in future pharmacare expansions.
• Keep receipts, medical records, and communications from your insurer or pharmacy; they may be needed in appeals or transition periods.

Stay Informed & Engage

• Watch updates from your provincial health ministry or drug plan for implementation timelines, formulary changes, or enrollment instructions.
• The new Canada’s Drug Agency (CDA) will lead the development of the national formulary over time. Public consultations are underway for which drugs to include next.
  (See “National Pharmacare: Canada’s Drug Agency Consultation” for current input timelines.)
• Advocacy groups, patient associations, and pharmacists will likely play a role in shaping coverage standards—consider engaging (for example via local forums or public consultations).

Conclusion

Canada’s new national pharmacare initiative marks a major shift in how prescription drugs may be covered across the country. It builds on existing provincial systems and aims—over time—to ensure everyone, regardless of income or province, can access essential medicines without financial hardship.

But it’s not a done deal yet. The success of pharmacare hinges on provincial cooperation, sustainable funding, and careful formulation of what drugs to include. For now, individuals should check their province’s status, review their current coverage, and stay alert for updates.

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