Does Health Insurance Cover Prescription Drugs in Canada?
TL;DR: Does health insurance cover prescriptions?
Canadians usually have some health insurance coverage for prescription medications through either federal drug benefit programs, provincial pharmacare plans, and/or group and private health insurance plans. Only prescriptions administered in a hospital setting are consistently covered by public health insurance for all Canadians.
Eligibility for prescription coverage under public health plans often depends on age, income, or health conditions, and varies from province to province. Many Canadians need to supplement their prescription drug coverage through group health insurance tied to their employment or through private health insurance. For some, paying out of pocket for occasional prescriptions not covered by public health care is the most cost-effective option.
How prescription drug coverage works in Canada
In Canada, insurance coverage for prescription drugs falls into four categories: federal program, provincial drug plans, employer-sponsored group healthcare benefits, and private health insurance.
For most Canadians, provincial drug benefit programs are the first line of coverage for prescription drugs. But if your province doesn’t have a drug benefit plan—or if public health care only covers prescriptions for select groups, such as children or low-income households—you may need to turn to group or private health insurance to get your prescriptions covered.
Under the Canada Health Act, all prescription drugs administered in a hospital setting are covered by provincial healthcare plans.
Does private health insurance cover prescriptions?
Most private health insurance plans cover a portion of the cost of generic prescription drugs. Depending on the plan, private health insurance may cover any prescription with a drug identification number (DIN) or only those listed on the provincial formulary or drug benefit list.
Each private health insurance plan comes with a different set of limitations on prescription drug coverage. Some plans, for instance, cover brand-name prescription drugs, while others only cover generic medications. Private prescription drug coverage may also be subject to annual maximums, deductibles, dispensing fees, and exclusions.
Private health insurance is generally a means to supplement—not replace—public or group coverage.
Most provinces provide some level of public health insurance coverage for prescription drug products, so it’s important to understand the coverage you already have under your provincial plan and make sure that your private insurance doesn’t duplicate it.
What types of prescriptions are covered by private health insurance?
Private health insurance covers most prescriptions with a DIN in Canada, including:
- Ongoing maintenance medications
- Acute medications (e.g., antibiotics)
- Some specialty or high-cost drugs, with limitations
- Drugs listed on your provincial formulary or drug benefit list
Not all private health insurance plans cover pre-existing prescription drug costs, so be sure to research any plan before purchasing if you’re looking for coverage for drugs you already take.
Drugs that often aren’t covered by private health insurance include:
- Weight loss drugs
- Smoking cessation drugs
- Infertility drugs
- Erectile dysfunction drugs
- Birth control
- Medical marijuana
- Vaccines
- Any brand-name drugs
Depending on your province, some of these may be covered by a provincial or federal drug benefit program, or you may need to purchase a premium health insurance plan with more extensive prescription coverage.
Is private health insurance worth it for prescriptions?
For many Canadians, private health insurance plans can help reduce the cost of prescription drugs and other common medical expenses not covered by public healthcare systems.
If you’re only interested in prescription drug coverage, a private health insurance plan probably isn’t the most cost-effective option. Any private plan with coverage for prescription drugs typically includes coverage for things like dental care, vision services, paramedical services, mental health care, medical equipment, in-home care, and more. If you know you’re unlikely to use that coverage, the benefit of prescription drug coverage likely isn’t worth the full cost of the policy.
A private health insurance plan for prescription drug coverage may be worth it if…
Paying out of pocket for prescription medication costs may be cheaper if…
How to choose the right prescription coverage
To choose the right health insurance for your prescription medications, start by assessing your current and expected needs:
- How much are you paying for prescriptions right now? Be sure to review the details of any public drug benefit program or group health coverage you may be eligible for to make sure you’re not overpaying for prescriptions.
- Do you take regular prescriptions that aren’t covered by your current insurance? If so, check the details of any private plan to ensure these medications are covered.
- Do you need additional health insurance benefits? Evaluate your dental insurance needs, as well as other medical costs not covered by provincial health care.
Request health insurance quotes and compare the cost of a private health insurance plan with your current prescription spending. Remember to check for exclusions, maximums, deductibles, and other limitations on any private health insurance plan before buying.
FAQ: Does health insurance cover prescriptions?
Prices listed on this page are based on information available as of October 2025. The prices shown are for general reference only and may vary based on factors like your age, location, and product selection.