7.14 National Pharmacare (Plan NP)

General Policy Description

Plan NP provides 100% coverage of select diabetes medications, menopausal hormone therapy (MHT), and contraceptives. The federal government contributes funding for national pharmacare.

The Full Payment Policy applies to eligible prescription costs under Plan NP. Providers must not charge patients any costs associated with the dispense of any 100% covered Plan NP prescription medication.

Policy Details

Patient eligibility

All B.C. residents enrolled in MSP are automatically enrolled in Plan NP. Plan NP coverage is provided at the pharmacy and processed in PharmaNet, as with all PharmaCare plans.

Exceptional coverage

Exceptional coverage is available for up to 3 months for B.C. residents who have completed the Application for Health and Drug Coverage (AHDC), presented their identification at an ICBC driver licensing office, and are in the wait period for MSP

To secure coverage for these clients:

1. Pharmacist confirms with client that they have completed both steps of MSP enrolment and are in the wait period.
2. Pharmacist contacts the PharmaCare Help Desk and provides the patient's name, PHN, date of birth, and B.C. address.
3. Health Insurance BC (HIBC) confirms that the client has completed both MSP enrolment steps, and if so, activates coverage for 3 months.

Plan NP Benefit List

Health providers can review the Plan NP benefit lists on these new web pages:

• National Pharmacare (Plan NP) 
  • Plan NP menopausal hormone therapy (MHT) 
  • Diabetes medications 

The contraceptives previously covered under Plan Z are now covered under Plan NP. 

Some benefits are subject to Low Cost Alternative (LCA) pricing. The public is encouraged to ask their pharmacist or prescriber to adapt to or prescribe fully covered benefits. 

PharmaCare's Full Payment Policy applies to Plan NP benefits with 100% coverage, including insulins. This means pharmacies cannot charge a client for the medication or any service associated with the dispense. Insulin was previously unregulated and covered at retail price. 

Special Authority Coverage

Several Plan NP diabetes benefits will continue to require Special Authority (SA). Once SA is approved, the benefits have 100% coverage and the Full Payment Policy applies (LCA pricing may apply for some products). 

No MHTs or contraceptives will require SA. 

Pharmacists cannot apply for SA for Plan NP benefits; however, they can draft an SA request for a prescriber to review, sign and submit. 

Resources:

• BC Provincial Academic Detailing (PAD) service Medications for menopause-associated vasomotor and genitourinary symptoms 
• National Pharmacare (Plan NP) 
  • Plan NP menopausal hormone therapy (MHT) 
  • Diabetes medications 
• National pharmacare in B.C. website