TL;DR
- National pharmacare’s expansion has stalled — only B.C., Manitoba, P.E.I. and Yukon have signed on.
- For employers the effect depends on your province: a modest saving in B.C. and Manitoba, no change in Saskatchewan and Ontario.
- Alberta is the outlier — Bill 11 would push employer drug costs up from summer 2026.
You’ve probably seen the headlines about national pharmacare…
The headlines focus on the federal politics. For your plan, the part that actually matters is quieter: which claims move to the public system, which stay with you, and how that differs by province.
National pharmacare in 2026: expansion is on pause
The first phase of national pharmacare covers two things for residents in provinces that have signed an agreement with Ottawa:
- Prescription contraceptives
- Some diabetes medications
As of mid-2026, four jurisdictions have signed: British Columbia, Manitoba, Prince Edward Island, and Yukon. That’s it. CBC Reporting indicates only about 17% of Canadians are covered under these deals, and Ottawa is NOT currently in talks with the remaining provinces. Federal signals in the Spring 2026 fiscal update also point AWAY from new money for additional deals.
So if you were waiting for a national program to absorb a chunk of your drug spend, that broad expansion isn’t on the calendar right now.
What you we do have is a patchwork, which honestly we had in the first place.
First, one things to note: coordination of benefits
Coordination of benefits (COB) is simply the rule that decides which plan pays a claim first when more than one plan could cover it. The plan that pays first is the “first payer” (or “payer of first resort”); the one that picks up what’s left is the “payer of last resort.”
That single rule, who pays first, is the whole story here. In most of the country, public pharmacare pays first for the covered drugs, which takes those claims off your plan. In one province, the order is about to flip the other way.
Where national pharmacare lowers employer drug costs
In the signed provinces, the public plan pays first for covered contraceptives and diabetes medications. Your plan simply stops seeing those claims, and members don’t have to do anything different at the pharmacy.
The data backs this up. TELUS Health’s 2026 Drug Data Trends report found the number of people claiming contraceptives on private plans fell sharply where public coverage took over:
One nuance worth knowing: B.C.’s drop traces back to the province’s own free-contraception program, which launched in April 2023 and only became federally funded under national pharmacare in March 2026 — so in B.C. the saving started before the federal deal. Diabetes drugs and devices remain the single largest private-plan drug category, but their share of private spend has been sliding too, from 15.7% in 2023 to 13.2% in 2025.
How big is the saving overall? From where we sit it’s minor, you might see a few per cent come off the drug side of your plan (could be up to 5%), but there are a lot of variables.
For Example:
- A 40-person professional-services firm in B.C
- Spending $1,000 per year on Diabetes medication for the whole group
- 3% of total drug spend
- This is likely one member, if a group has multiple members this category is higher
- Once the public plan took first-payer position and medications are aligned to the eligible list, those claims simply stopped hitting your benefits plan.
- For a plan this size the saving is modest. -3% on total drug spend doesn’t result in hundreds of dollars savings on premiums or ASO deposits. But for a plan with multiple members and more drastic Diabetes spend it can have more impact.
If contraceptive and diabetes claims come off your plan, and will open up impactful savings, that’s room you can redeploy into supportive ancillary benefits or enhance existing coverage: mental health, paramedical, or dental.
That’s a conversation worth having at your next renewal.
Where it raises employer drug costs: Alberta
Alberta is moving in the opposite direction. The province has NOT signed a federal pharmacare deal, and new provincial legislation (Bill 11) is set to make the public plan the payer of last resort. This means employer plans would pay drug claims FIRST, with the public plan covering the remainder. Yep, you read that right, it’s backwards!
That’s a reversal of the long-standing arrangement, with the change planned for summer 2026.
In practical terms: claims your plan never used to see become your plan’s responsibility first. That pushes employer drug costs up, and the pressure lands hardest on plans with high-cost claimants, where the public plan was previously absorbing the first dollars. For some plans it can also feed into pooling and stop-loss charges at renewal.
For Alberta employers this is a cost increase, not a saving. We’ve written a separate, detailed breakdown of who’s affected and what to do about it.
The five-province snapshot
Here’s where each of our five core provinces stands as of mid-2026:
What to do with this
If your team is in B.C. or Manitoba, the move is to confirm the savings showed up and decide where to put them.
If you’re in Alberta, the move is to model the Bill 11 impact before summer. If you’re in Saskatchewan or Ontario, nothing changes yet — but the map is shifting, so it’s worth knowing where things stand.
None of this is about chasing the lowest rate. It’s about understanding what your plan is actually paying for, and making sure every dollar is doing something your people value.
Want a plain-language read on what pharmacare is doing to your plan specifically — province by province?
Our monthly benefits brief breaks down developments like this one as they happen. Already weighing a change for your own plan? Book a call with us and we’ll walk through your province.
Common questions
Does national pharmacare replace my employee drug plan?
No. It covers specific contraceptives and diabetes medications, and in signed provinces it pays first for those. Your plan still covers everything else, exactly as before.
Do my employees have to do anything differently at the pharmacy?
No. In the signed provinces, coverage is automatic at the counter — there’s no form to submit and nothing for members to register.
Is my province part of this?
B.C. and Manitoba are (along with P.E.I. and Yukon). Saskatchewan, Alberta and Ontario have not signed, so in those provinces your plan stays the first payer on these drugs — for now.
Will this lower our premiums?
It can take a little pressure off the drug side of your plan in signed provinces, but the effect is modest and depends on your plan’s mix of claims. Treat it as room to redeploy, not a guaranteed rate cut.
Why would Alberta cost us more?
Alberta’s Bill 11 would make the public plan the payer of last resort, so employer plans pay drug claims first. That’s a reversal of the usual order, and for Alberta employers it pushes costs up rather than down.
Sources
- TELUS Health — 2026 Drug Data Trends & National Benchmarks
- Government of B.C. — National Pharmacare (Plan NP)
- Government of Manitoba — Enhanced Pharmacare Program
- Health Canada — About national pharmacare
- CBC News — pharmacare future (Nov 2025)
- HRD Canada — Is Ottawa stepping back from national pharmacare? (May 2026)
