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BC PharmaCare Plan G Application (HLTH 3497)

This two-page application enrols a patient in PharmaCare Plan G, psychiatric medication coverage for people whose medication cost is a significant barrier and who have no other coverage. The prescriber certifies the clinical need, and the local mental health and substance use or child and youth mental health centre approves coverage for up to one year. A three-month bridge option serves urgent after-hours cases.

Who completes it

The patient signs section A, the prescribing practitioner (physician, nurse practitioner, RN or RPN) signs section B, and the director or designate of the local MHSU centre, CYMH centre or health authority completes approval section C.

Submitting and payment

How to submit it
The practitioner faxes the form to the local MHSU centre, CYMH centre or health authority mental health contact, which approves it and faxes it to Health Insurance BC; bridge applications go directly to HIBC.

Good to know

  • Section B requires certifying that the patient was hospitalized for a psychiatric condition, or that without medication they would likely be hospitalized or someone would likely suffer serious harm or economic loss.
  • Bridge coverage (section D) lasts 3 months and comes from ED, RAAC, UPCC, health authority withdrawal facility or corrections prescribers; the patient should see a community prescriber within ten weeks.
  • New B.C. residents without MSP can get exceptional coverage (section E) for six months only, with no renewal, while they enrol in MSP.
  • If the patient cannot sign, write 'verbal declaration' in the signature box and sign as witness; if unwilling, a legally empowered representative may sign instead.

Get the official form

Download the current version from the source each time; forms change without notice.

Application for PharmaCare Plan G (Psychiatric Medication Coverage)

Official pagePDF

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

How long does PharmaCare Plan G coverage last?

Up to one year, after which the practitioner may re-apply for continued coverage, and the approving centre can set a shorter expiry. Bridge coverage lasts three months, and exceptional coverage for new residents without MSP lasts six months and cannot be renewed.

Who approves a Plan G application?

The director or designate of the patient's local mental health and substance use centre, child and youth mental health centre, or the health authority's mental health contact completes section C and faxes the approved form to Health Insurance BC. Only urgent after-hours bridge applications skip this step.

Who can sign section B of the Plan G application?

The prescribing practitioner, who checks their profession as nurse practitioner, registered psychiatric nurse, registered nurse or physician and gives their college ID number rather than an MSP billing number, then certifies which of the three clinical criteria applies.