Reform tracker · Canada
Public funding for nurse practitioner and pharmacist primary care
Under a new federal interpretation of the Canada Health Act, medically necessary care that nurse practitioners, pharmacists and midwives provide in place of a doctor is to be publicly funded. The policy took effect in April 2026, with penalties from April 2027. Ontario missed the deadline.
Status note: In force as federal policy from 1 April 2026. Penalties apply from April 2027 and may be retroactive; provinces must have begun covering these services by the end of 2028 (as reported from an unpublished December 2025 federal letter).
The stated rationale
Patients should not pay for medically necessary care just because a nurse practitioner or pharmacist provides it rather than a doctor.
What changed
From 1 April 2026, medically necessary “physician-equivalent” services provided by nurse practitioners, pharmacists and midwives are treated as insured services, so charging patients for them counts as extra-billing. Alberta already funds NP-led patient panels (since 2024), at roughly 80% of family doctor pay.
Why it matters
We think funding rules shape scope as much as regulation does: once a service is publicly funded, it tends to stay.
Who supports it
Not yet documented.
Who has raised concerns
- Ontario Government says letting NPs bill OHIP directly needs negotiation with the OMA
Sources
- Torys: Updates to the new interpretation of the Canada Health Act (March 2026)
- Osler: A letter, not a law (March 2026)
- CP24: Ontario misses deadline on nurse practitioner funding (April 2026)
- CTV Edmonton: NPs to make 80% as much as family doctors (April 2024)
- Alberta Health: Nurse Practitioner Primary Care Program guide (2024)