‘Women who need access to care under the current arrangement here in BC can have access to that care,’ says Sarah Hoffman
British Columbia recently followed in Manitoba's steps to offer 100 per cent publicly funded menopausal hormone therapy (MHT) for midlife and aging women. For plan sponsors, it’s a policy shift that raises an uncomfortable question in every other province.
If a public system can cover this, why haven't private plans done more?
Sarah Hoffman, CEO of Pacific Blue Cross, believes the move reflects a broader realization with how benefit plans have failed women.
"We know historically that women's health, just by its nature, has been underrepresented in the research space. And because we haven't done a ton of work on women's health from a research lens, we haven't tailored benefit plans to then meet the needs of women, because historically, we have used the average aged male as our research subject," she said.
That gap is now closing, and it’s notably beginning to show up in claims data. Rising costs tied to women's health aren’t a spending problem, Hoffman argues, but rather a correction.
“Where we're seeing an increase in costs related to women's health, I think is a recognition of a few things. It's recognizing that we're looking at women as independent and unique, and their healthcare needs are independent and unique. The generation of women that we've got today are more vocal with respect to their healthcare needs, and so they're coming forth with clear articulation of what it is they need to be fully supported,” Hoffman added.
“We're also recognizing that women's health is more than just having babies. It's making sure we're taking care of their physical wellness, their mental wellness. What we're actually seeing now reflects the costs associated with those changed benefit plans.”
BC's new MHT program is the sharpest example of that shift. Under BC PharmaCare’s Plan NP, eligible women can access covered menopausal hormone therapy on an ongoing basis, from estrogen, progesterone, and other treatments tailored to individual symptoms. Hoffman noted that the coverage isn’t just a one-time benefit.
"It means that women who need access to care under the current arrangement here in BC can have access to that care," said Hoffman, adding the program could expand over time as women keep pressing for broader coverage and more treatment options in the public system.
Additionally, under Plan NP, topicals and patches are covered while prior authorization requirements have been removed, which makes access easier in practical terms.
From Pacific Blue Cross’ perspective, she sees a longer-term opportunity to help shape policy with data on how women are using healthcare services, provided that information is handled carefully and responsibly.
She believes BC is in a strong position because the provincial government will act as the first payer for many hormone replacement therapy claims, giving women access through the public medical services plan while Pacific Blue Cross steps in with wraparound coverage for needs that fall outside it.
Even if MHT use rises over time, Hoffman suggests the impact on private plans should be moderated. She also expects uptake to grow as treatment becomes easier to access, more openly discussed, and less intimidating for women to pursue.
While BC’s new MHT coverage is a meaningful first step, Hoffman cautions that it’s not yet comprehensive as she notes the current public plan appears to cover only a limited set of hormone therapies, leaving out some treatments that go beyond the standard formulary.
Additionally, she also points out that women’s healthcare needs are often more complex than any fixed list can capture, so there will still be gaps for people with more specific or less common requirements.
Even so, she views the government’s initial coverage list as a solid foundation that could be expanded over time as policymakers respond to individual care needs more fully.
"I think this is a great starting point," she said. "The government has started off on a really good footing with what they've included in the list."
Canada’s first complex menopause clinic
Meanwhile, BC has opened a complex women's health menopause clinic at BC Women's Hospital, which Hoffman sees as another sign that menopause is starting to be treated as a serious healthcare specialty rather than a side issue.
She suggests the clinic is likely the first of its kind in Canada and says it is designed to support women whose menopause journeys involve more complicated medical needs.
Hoffman also indicates that the clinic could add useful context to any broader reporting on women’s health policy in BC. Pacific Blue Cross has been involved financially, she noted, helping support the clinic itself as well as related research and menopause education.
Still, progress in this area depends not just on coverage, but on investment in specialist care, research, and clinician education. And while menopause and perimenopause still carry some stigma, much like mental health once did, Hoffman believes that’s starting to fade. She suggests the conversation is becoming more normal in workplaces, including at Pacific Blue Cross, where menopause is discussed as a routine life stage rather than as an awkward or taboo subject.
“Overall, it looks like this is the pathway to future-proofing women's health when it comes to menopause and perimenopause,” said Hoffman.
