Information for Pharmacies

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 select 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 1, 2026, select diabetes and menopausal hormone therapies are eligible under Plan NP. You can view the list of eligible medications here:

   • Diabetes
   • Menopausal Hormone Therapies 

   Medication coverage begins March 1, 2026. 

   Eligibility

   All BC residents enrolled in Medical Services Plan (MSP) are automatically eligible for Plan NP. No separate application is required. Coverage will begin from the first dollar spent; there is no deductible under Plan NP.

   Members residing outside BC are not eligible for Plan NP.

3. How will Pacific Blue Cross process claims for Plan NP drugs?

   Fully covered medications

   For medications fully covered under Plan NP:

   • BC PharmaCare acts as the primary payer.
   • These claims are processed directly through BC PharmaCare and are not reimbursed through the Pacific Blue Cross plan.
   • The CPHA message returned is: “HD – Patient may qualify for govt program".

   For drug claims that satisfy BC PharmaCare’s full payment policy (including Plan NP medications), the unpaid remainder cannot be billed to Pacific Blue Cross  or the member. 

   Partially covered medications

   For medications partially covered under Plan NP:

   • BC PharmaCare pays up to the cost of a generic alternative (Low-Cost Alternative rule).
   • The remaining balance may be submitted to Pacific Blue Cross for adjudication.

   Reimbursement will depend on the member’s plan design.

   Special Authority medications

   The following medications require Special Authority approval from BC PharmaCare before they are eligible for coverage under Plan NP:

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

   Existing Special Authority approvals will carry forward under Plan NP.

   For members currently stabilized on these medications who are unable to obtain approved Special Authority under Plan NP, Pacific Blue Cross will continue coverage under the member’s existing plan. For new prescriptions, Special Authority approval through BC PharmaCare is required before coverage can be considered.

4. Should pharmacies continue to submit to Pacific Blue Cross first?

   No. For medications covered under Plan NP, BC PharmaCare remains the primary payer. Pacific Blue Cross will adjudicate only remaining eligible balances for partially covered medications.

5. What should we tell patients if they ask why PBC is not paying?

   Plan NP shifts payment responsibility for certain medications to BC PharmaCare.
   If the medication is fully covered under Plan NP, BC PharmaCare pays the full cost, and Pacific Blue Cross does not reimburse separately.