Federal health minister Mark Holland has announced provincial and territorial health plans will begin covering primary care services provided by nurse practitioners, pharmacists, and midwives starting April 1, 2026.
The policy change will allow these professionals to bill governments for medically necessary services, a measure intended to reduce financial barriers for patients.
Holland stated that regulated healthcare workers outside the physician category will be able to charge the healthcare system for services that would otherwise be provided by doctors. This adjustment follows concerns about patients paying out of pocket for necessary medical care, including services at private nurse practitioner clinics, The Canadian Press reported.
The new directive, part of a new interpretation of the Canada Health Act, aims to align billing practices with the principles of universal healthcare. Holland emphasized that patients should not be charged for services covered by the public system, and nurse practitioners should have the same billing rights as doctors.
“This interpretation letter shuts that down,” Holland said, referring to patients charged for public healthcare services. He added that the policy change empowers non-physician professionals to deliver the full scope of care they are trained to provide.
The directive will be enforced through federal health transfer payments, which could be reduced if provinces or territories charge patients for covered care.
Michelle Acorn, CEO of the Nurse Practitioners' Association of Ontario, described the change as the result of years of advocacy. She noted that some nurse practitioners have “reluctantly” charged for services, such as managing chronic diseases or providing birth control, due to being excluded from government billing frameworks.
The association does not expect the policy to significantly impact Ontario’s existing nurse-practitioner-led clinics, which are already government-funded. However, it is seen as a step toward expanding nurse practitioners’ ability to provide accessible care.
Claire Dion Fletcher, vice president of the Canadian Association of Midwives, said that while midwifery services such as prenatal and postpartum care are already publicly funded, the new billing framework could allow midwives to offer additional services. These may include testing for sexually transmitted infections, prescribing birth control, and providing abortion care and vaccinations.
Meanwhile, Joelle Walker, vice president of public and professional affairs with the Canadian Pharmacists Association, noted that pharmacists already deliver various levels of primary care, including prescribing medications in some jurisdictions. She expressed hope that the new policy would expand the range of services pharmacists can bill under provincial health plans.
Holland stated that the lead time for implementing the policy is needed to allow provinces and territories to adjust their health insurance plans.
Ontario’s Health Minister Sylvia Jones is reviewing the directive to assess its impact on publicly funded care in the province. In a statement, Ontario officials reiterated their plan to connect all residents to a primary-care provider within five years.
The announcement follows ongoing consultations between federal and provincial governments and builds on previous efforts to address gaps in the healthcare system. Holland acknowledged that billing for virtual care and telemedicine remains a separate issue under discussion.
“If you walk into a doctor’s office that is physical or virtual, both of those things should be covered by the Canada Health Act,” Holland said.
