The federal government issued a directive to all provinces that effective April 1, 2026, patients in Canada should not pay out-of-pocket for medically necessary services provided by nurse practitioners, pharmacists and midwives. 

What’s happening: The directive is not yet implemented in Manitoba, meaning patients may still be paying out of their own pockets for what Health Canada calls ​“physician-equivalent” services. 

• News this week focused on an NP charging patients for publicly insured primary care services. 

• Retail pharmacists in Manitoba have been pursuing an expanded scope of practice to offer more ​“primary care” in retail settings. 

What isn’t happening (yet): There is no immediate change that allows other providers to start billing fee-for-service. The federal directive does not specify how provinces should close the loophole, and certainly does not say NPs or pharmacists must be remunerated as physicians are. In fact, some provinces have already ruled out fee-for-service options.

Cons and Pros? The federal directive is intended to close a loophole allowing some providers to bill patients for medically-necessary care when physicians cannot. While it’s not yet clear how Manitoba will respond, we see legitimate concern about what the directive could mean, but also opportunity too. 

• Concern: If NPs and pharmacists can start billing independently, it could lead to more fragmentation and duplication, with more silos and gaps. 

• Opportunity: Team-based care. The directive could speed up efforts to expand team-based care in physician practices, both primary care and specialty. 

Bottom line: Doctors Manitoba supports covering care provided by other providers, but it must be done in a way that builds teams and fosters collaboration focused on patients, not more fragmentation, silos, and gaps. 

Share your feedback: Write to us at practiceadvice@​doctorsmanitoba.​ca to share your feedback on how you’d like to see the new directive take shape.