Free contraception program sharply reduces patient spending in British Columbia

Researchers at UBC found that B.C.'s decision to provide universal, no-cost prescription contraception sharply reduced what patients pay, with the largest financial gains for people in their 20s. Unaffordable contraception is linked to higher rates of unintended pregnancy, which carries significant consequences for health, education and economic equality.

Published in JAMA Health Forum, the study is the first to quantify patient cost impacts after B.C. introduced free prescription contraception in April 2023.

The highest payers gain the most

Before the policy, the pill averaged about $25 per month, while IUDs ranged from $75 to more than $500 up front-and for long-term pill users, lifetime costs could reach $10,000.

Nearly 40 per cent of prescription contraception was not covered by insurance, but was paid out of pocket by patients-the highest rate in Canada and well above most other prescription drugs. Among young adults, that figure was even higher at about 45 per cent. After implementation, their out-of-pocket share fell by roughly 33 percentage points. Across all patient groups, the share of prescriptions with any patient cost dropped to under 10 per cent and to five per cent for prescription contraceptives that were fully covered.

Two years later, patient spending was 83 per cent lower than expected, translating to average savings of $43 per contraceptive user per year.

People in their 20s are often in a coverage gap. They're off a parent's plan but not yet in jobs with benefits. This policy was particularly important for this group who were most likely to be paying out of pocket."

Dr. Elizabeth Nethery, lead author, postdoctoral researcher at UBC's faculty of pharmaceutical sciences

System costs stable as access expands

The study analyzed pharmacy data from all 10 provinces, using jurisdictions without universal coverage as a comparison. While patient costs fell sharply, total contraceptive spending across patients, insurers and the public system remained essentially unchanged after two years. Researchers also found increased uptake of long-acting reversible contraceptives, including IUDs and implants.

"Universal coverage works," said senior author Dr. Laura Schummers, an assistant professor at UBC. "Removing cost barriers increased uptake of the most effective methods, which helps reduce unintended pregnancy and inequality-adding to strong evidence that universal contraception coverage is essential in Canada."

In Canada, roughly two out of five pregnancies are unintended, disproportionately affecting people with fewer financial resources.

Policy momentum across Canada

Manitoba introduced a similar program in October 2024, with early results consistent with B.C.'s. At the federal level, Canada passed pharmacare legislation in 2024 committing to public coverage of contraception, although implementation agreements currently involve only three provinces and one territory.

The study was funded by the Canadian Institutes of Health Research and included researchers from UBC, the University of Calgary, the University of Manitoba, Simon Fraser University and the University of Ottawa.