What you need to know

1. What is the BC PharmaCare National PharmaCare Plan?

   The BC PharmaCare National Pharmacare Plan (Plan NP) is a program created through a partnership between the provincial and federal governments to provide many diabetes therapies and menopausal hormone therapies (also known as hormone replacement therapy) to British Columbians at no cost.

2. What is covered under Plan NP?

   As of March 01, 2026, select diabetes and menopausal hormone therapies are eligible under Plan NP. You can view the list of eligible medications on either of the Pharmacare websites listed here:

   • Diabetes
   • Menopausal Hormone Therapies 

   Because Pacific Blue Cross already coordinates closely with BC PharmaCare, most members can expect a smooth and seamless experience when filling prescriptions under Plan NP.

3. Who is covered under Plan NP?

   All BC residents enrolled in MSP are automatically eligible for Plan NP coverage. There is no separate registration required. Coverage begins from the first dollar spent. There is no deductible under Plan NP.

4. Will I still use my Pacific Blue Cross plan?

   Yes. Your Pacific Blue Cross plan continues to provide coverage for many other prescription medications and health services. For medications fully covered under Plan NP, BC PharmaCare will pay the cost directly at the pharmacy. For partially covered medications, your Pacific Blue Cross plan may cover part or all of the remaining eligible cost, depending on your plan design.

5. How does Plan NP work?

   Fully covered medications

   If a medication is fully covered under Plan NP, BC PharmaCare will pay the cost directly at the pharmacy. These medications will not be reimbursed through your Pacific Blue Cross plan. 

   Partially covered medications

   Some medications are partially covered under Plan NP. In these cases, BC Pharmacare covers up to the cost of a generic alternative. Depending on your plan design, Pacific Blue Cross may reimburse part or all of the remaining eligible cost.  

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   Did you know:

   Many partially covered drugs under Plan NP are brand name medications that have generic alternatives. If a generic option is available and dispensed by your pharmacy team, the medication may be fully covered.

   Medications requiring Special Authority

   A small number of medications require Special Authority approval from BC PharmaCare before they are eligible for coverage under Plan NP. These include:

   • Saxagliptin or Saxagliptin/Metformin (also know as Onglyza or Komboglyze)
   • Linagliptin or Linagliptin/Metformin (also know as Trajenta or Jentadueto)
   • Pioglitazone (also know as Actos)

   Many members currently taking these medications already have an approved Special Authority from PharmaCare. These approvals will be carried over to Plan NP and provide full coverage. If you are currently taking one of these medications and are unable to obtain Special Authority approval under Plan NP, Pacific Blue Cross will continue to provide coverage under your existing plan so your access to medication is not interrupted.

6. How will members know if their drug is covered under Plan NP?

   On your Member Profile or the PBC Mobile app 

   A search using the Drug Lookup Tool will return a “not covered” or “may be covered” message. If you reside within BC, you will see one of the following two messages for drugs that are covered under Plan NP.

   Message 1

   Not Covered

   Message Returned:

   (None)
   *If no message appears, this typically indicates the medication is fully covered under Plan NP and processed through BC PharmaCare.
   

   What does this mean?

   Drugs that are fully covered under Plan NP are processed directly through BC PharmaCare and are not reimbursed through your Pacific Blue Cross plan. Partially covered drugs will only be considered after BC PharmaCare has made a partial payment for one of these drugs.

   Message 2

   May Be Covered

   Message Returned:

   This drug may be eligible under PharmaCare’s Special Authority Program. Please consult with your doctor or nurse practitioner who may apply on your behalf. If your application is approved, your pharmacist will submit the required information with your claim.

   What does this mean?

   Drugs that require Special Authority are only covered if you receive approval from BC PharmaCare under Plan NP. If your request is denied by PharmaCare, the drug is not eligible under your plan.

   Message 3

   Covered

   Message Returned:

   No message

   What does this mean?

   For partially covered medications, BC PharmaCare will pay up to the cost of a generic alternative (Low-Cost Alternative rule). 
   Depending on plan design, Pacific Blue Cross may reimburse part or all of the remaining eligible cost.

   At the pharmacy

   The major difference you will see is who is paying for your medication. Fully covered drugs will be paid for, in full, by BC PharmaCare. Partially covered medications under Plan NP may receive additional coverage provided by PBC, depending on the design of your policy.

   If your drug requires Special Authority in order to be covered, your pharmacy will receive a message stating “Patient may qualify for govt program”.

7. What are the changes for members who are already taking a medication that is covered under Plan NP?

   Members who are taking a fully covered medication under Plan NP that does not require Special Authority will likely see no disruption in accessing their medications.

   Members who are currently taking a drug that requires Special Authority under Plan NP will not lose coverage of those drugs. We still encourage you to apply for coverage under Plan NP, but in the event that your request is ultimately denied, you will not lose access to the drug you have been taking.

8. How do I find out if my Special Authority has been approved?

   There are several ways to check the status of your Special Authority application with BC PharmaCare:

   BC Health Gateway: The easiest way to check the status of your Special Authority application is through the BC Health Gateway.

   Visit www.healthgateway.gov.bc.ca to log in or create an account

   1. Select Health Records from the list of options.
   2. Select Special Authority under the list of categories.

   You will be able to see the status of your application if it has been received or processed by BC PharmaCare.

   PharmaCare response letter: BC PharmaCare will send you a written response by mail once your request has been approved or denied.

   Ask your pharmacy team: You can ask your pharmacy team to do a test claim on your behalf. This is a frequent standard of practice and can be done at no cost to you. Please note: the pharmacy will only be able to tell you if your request was approved and the expiry date if it is active. They cannot confirm the status of a pending or rejected request.

   Ask your prescriber: Your prescriber will also receive a response from BC PharmaCare indicating their decision.

9. Do I need to submit a copy of my Special Authority letter to Pacific Blue Cross?

   For the majority of eligible medications, our system can read the approval codes from BC PharmaCare and approve your claim automatically. Unless you are experiencing difficulty having your claims approved, you do not need to submit a copy of your Special Authority approval letter to us. However, please keep a copy of the letter in a safe place in case you do need to submit it.

   Proof of PharmaCare Special Authority can be any of the following:

   • A copy of the Special Authority Approval letter mailed to you by PharmaCare.
   • A copy of the response from BC PharmaCare that was faxed or mailed back to your prescriber.
   • A screenshot from your BC Health Gateway account that includes the expiry date (if applicable) of your Special Authority.
   • A copy of your official prescription receipt that includes a “BCSA1000” or “BCSA1100” code issued by BC PharmaCare.
10. Will this affect my premiums?

    Plan NP applies to a specific group of medications. There are no changes to your coverage or plan premiums as a result of this update.

11. Does Plan NP replace private health coverage?

    No. Plan NP covers a specific list of medications.  Your Pacific Blue Cross plan continues to provide coverage for many other prescriptions and health services.