Navigating medication coverage in British Columbia is hard enough for most people. For students with ADHD, it can feel impossible.
On paper, it seems like the provincial formulary (the list of drugs covered under BC’s PharmaCare program) is designed to make essential medications accessible. In reality, its lack of nuance means that for many students, “coverage” is only theoretical. It covers just a narrow range of ADHD medications, and often not the ones that actually work best for the people who need them.
For example, methylphenidate, the generic form of Ritalin, is covered, but only in its short-acting and sustained-release forms. The longer-acting, controlled, or extended-release options like Concerta aren’t. That might not sound like a big difference on paper, but in practice, it’s huge. Shorter-acting medications wear off quickly, meaning students often have to take multiple doses throughout the day to stay focused and functional. For people with ADHD (whose symptoms include forgetfulness, time blindness, and difficulty with routine) that’s asking a lot. Missing even one dose can derail an entire day.
The situation is even worse for those who can’t tolerate stimulants at all. Strattera, a non-stimulant ADHD medication, can be life-changing for people who experience side effects or contraindications with stimulants. It’s also prohibitively expensive, and BC doesn’t cover it. The only other non-stimulant option, Intuniv, is similarly costly and uncovered. So, for many students, it’s either pay hundreds out of pocket each month or go without the medication that allows them to function.
The province does have a system for making exceptions through special authority—a process that allows patients to apply for coverage of drugs not normally listed on the formulary. In theory, this provides flexibility. In practice, it’s a bureaucratic maze.
To qualify for special authority, a student often has to stop taking their current medication and “fail” on a cheaper, covered alternative first. That means weeks of instability, withdrawal, and, potentially, academic chaos while they try something that might not work. Then they must book follow-up appointments (not easy when family doctors are scarce), have their doctor complete and submit the paperwork, and wait—sometimes for weeks—for a decision. If any information is missing or entered incorrectly, the whole process restarts.
For neurotypical people, that’s frustrating. For someone with ADHD, it’s almost impossible to manage. The irony is striking: the very symptoms of ADHD that medication can help with (executive dysfunction, difficulty with organization, forgetfulness) make navigating this system especially difficult.
What makes this extra unfair for students is that losing coverage often coincides with major life transitions.
A student moving from their parents’ insurance to a student plan, or from full-time work to full-time study, might suddenly lose access to the medication that helped them succeed in the first place. It’s an impossible situation: pay out of pocket, jump through administrative hoops, or go without.
None of these options are acceptable.
This isn’t just a student issue, it’s an equity issue. The formulary’s one-size-fits-all approach punishes those whose needs don’t fit neatly into bureaucratic boxes. It assumes everyone can access a family doctor, manage complex paperwork, and afford to wait weeks without essential medication.
Fixing this requires more than tinkering with coverage lists. It means recognizing that access to medicine is about practicality, not just policy. BC should expand coverage to include long-acting and non-stimulant ADHD medications, and simplify the special authority process, especially for conditions like ADHD, where executive dysfunction is a defining feature.
Students deserve drug-coverage systems designed for real people, not ideal ones. Because right now, the formulary fails the very people it’s supposed to help.