Canada’s National Pharmacare Act: Contraception and Diabetes Coverage

Canada’s National Pharmacare Act sets the coverage and eligibility rules for a federal single-payer drug program that, in its first phase, pays the full cost of prescription contraception and diabetes medications and supplies for residents of provinces and territories that have signed a bilateral agreement with the federal government. The Act received royal assent on October 10, 2024, and the first coverage start dates fall in 2026.¹ If you live in a participating jurisdiction, have a valid provincial or territorial health card, and have a prescription for a covered product, you pay nothing at the pharmacy counter.²

What Contraception Is Covered

The contraception list is broad and covers both medications and devices. It includes oral contraceptive pills, copper and hormonal intrauterine devices (IUDs), injectable contraceptives, hormonal implants, hormonal vaginal rings, and emergency contraceptives.³ The device itself is covered, not only the prescription that goes with it.

What Diabetes Medications and Supplies Are Covered

For diabetes, the program covers several insulin formulations, including rapid-acting, short-acting, and long-acting types, along with oral glucose-lowering drugs such as metformin and SGLT2 inhibitors. It also pays for the supplies needed to administer treatment and monitor blood sugar, including syringes, pen needles, and glucose test strips.⁴ Supplies matter here. For someone paying out of pocket, test strips and needles alone can run hundreds of dollars a year.

Other prescription categories, including cancer treatments, respiratory drugs, and mental health medications, are not part of this first phase. If your prescription falls outside contraception or diabetes, pharmacare does not pay for it, and you continue to rely on whatever coverage you already have.

What You Pay

The Act provides “first-dollar coverage.” The government pays the full cost from the first dollar. There are no deductibles, no copays at the pharmacy counter, and no out-of-pocket costs for the covered medications and products.⁵ This applies whether or not you already have private insurance or provincial drug coverage.

If you have a private drug plan that already covers some of your contraception or diabetes costs, pharmacare picks up whatever portion you would otherwise pay yourself, meaning your copay or coinsurance. If you have no drug coverage at all, pharmacare covers 100% of the cost.⁶ The Act does not require employers to change, drop, or modify existing private drug benefit plans.⁵

Who Qualifies

Three requirements apply.²

You are a resident of a province or territory that has signed a bilateral pharmacare agreement with the federal government.
You are eligible for public health insurance in that province or territory.
You have a valid prescription from a licensed healthcare provider for a covered medication or product.

There is no income test, no employment requirement, and no age limit. Residency standards are set by each provincial or territorial government and typically require living in the jurisdiction for a minimum number of months per year. If you already have a valid provincial or territorial health card and live in a participating jurisdiction, you qualify.

How to Get Covered Medications

The process happens at the pharmacy counter. Get a prescription from a licensed healthcare provider, take it to a pharmacy in a participating province or territory, and present your provincial or territorial health card. The pharmacist processes the claim through the public insurance system, and you leave without paying for the covered medication.²

The pharmacy handles the billing. Reimbursement flows from the government directly to the pharmacy, so you do not submit claims, wait for refunds, or shuttle paperwork between insurers.

Where Pharmacare Is Available

The Act does not force any province or territory to participate. The federal health minister negotiates individual bilateral agreements with each jurisdiction.⁵ As of early 2025, four jurisdictions had signed:

Manitoba: February 27, 2025
British Columbia: March 6, 2025
Prince Edward Island: March 7, 2025
Yukon: March 20, 2025

Signing an agreement is not the same as coverage starting. British Columbia’s agreement sets a coverage implementation date of March 1, 2026, which gives a sense of the gap between the signing date and when free prescriptions actually appear at the pharmacy counter.⁷

Residents of provinces and territories that have not signed cannot access pharmacare benefits until their governments reach agreements with Ottawa.⁴ If you live in one of those jurisdictions, you continue relying on whatever mix of private insurance, provincial drug plan, and personal spending you had before.

What May Be Added Later

The Act requires the federal health minister to ask Canada’s Drug Agency to prepare a list of essential prescription drugs to inform development of a broader national formulary. The statutory deadline for the initial list was October 10, 2025, one year after royal assent.⁵

Canada’s Drug Agency published an initial proposed list in June 2025 and held public consultations through mid-July 2025. The agency described the list as a “starting point” rather than a comprehensive formulary, focused on commonly prescribed drugs that have been proven safe, effective, and good value. The World Health Organization’s Essential Medicines List also informed the process.⁸ During the consultation, 51 of 84 submissions asked for additional drugs to be considered. The three therapeutic categories most frequently requested for inclusion were cancer and immunomodulating drugs, digestive and metabolic treatments, and respiratory medications.⁹ The advisory panel acknowledged that its methodology favored established treatments, so newer drugs may not appear on the list in the near term.

The Act also requires the health minister to establish a committee of experts, within 30 days of royal assent, to advise on how to operate and finance a full national, universal, single-payer pharmacare system.¹⁰ Expanding coverage beyond contraception and diabetes will require new bilateral agreements with the provinces and territories and additional federal funding, neither of which is guaranteed by the current Act.

1
Parliament of Canada. C-64 (44-1) – LEGISinfo
2
Government of Canada. National Pharmacare – Who Is Covered
3
Library of Parliament. Legislative Summary of Bill C-64 – An Act Respecting Pharmacare
4
Health Canada. National Pharmacare Bilateral Agreements
5
Justice Laws Website. S.C. 2024, c. 24 – Pharmacare Act
6
Office of the Parliamentary Budget Officer. An Act Respecting Pharmacare
7
Health Canada. Universal Access to Contraception and Diabetes Medications – British Columbia
8
Health Canada. Letter to the President and Chief Executive Officer of Canada’s Drug Agency
9
Canada’s Drug Agency. What We Heard – Summary of the Online Engagement Report on the Proposed List of Essential Prescription Drugs and Related Products
10
Justice Laws Website. Pharmacare Act – Full Text