Changes to Drug Reimbursement in Quebec – Bill 28

September 14th, 2015

The Quebec government passed Bill 28 on April 20th, 2015, and some of the measures included in this legislation will amend the Act regarding Prescription Drug Insurance. One of those measures directly impacts private drug plans: the elimination of the minimum reimbursement clause (set to 66% since July 1st, 2015). As of October 1st, 2015 , private plans will limit the reimbursement to what is considered eligible under the contract, and any excess amount will be billed to the member.

This change will affect employer-sponsored drug plans that already include drug management techniques, such as Generic Substitution and/or Reasonable and Customary (R&C) Limits on pharmacist fees.

 

Generic Substitution

Before October 1st, private plans had to always reimburse at least 66% of the total submitted amount for each prescription, whether the drug being filled was a brand name drug or a generic version. With the elimination of this clause, private plans will be limited to what is deemed eligible under the contract, in this case, the cost of the generic equivalent. Members who had decide to continue taking the brand name drug and pay any difference out-of-pocket will have to pay a higher amount as of October 1st.

Plan members opting for the generic version of the drug (where one is available) may be a consideration if they want to avoid paying additional amounts out-of-pocket.

 

R&C Limit on Pharmacist Fees

The portion of the cost of medications allotted to pharmacist fees varies from one pharmacy to the next, and some private plans include a cost control measure that limits those fees to what is deemed Reasonable and Customary. When the fees exceed this limit, the member must pay the excess out of their pocket.

Before October 1st, the legislation in Quebec required private plans to cover a portion of those excess fees, so that the member would always receive a minimum reimbursement of 66%. With the elimination of this clause, the plan will now only reimburse what is deemed eligible, which is the portion of the pharmacist fees that fall within what is considered to be Reasonable and Customary.

Plan members should consider comparing prices at different pharmacies to ensure that they are paying the lowest pharmacist fees.

 

RAMQ Co-Pay Maximum

Bill 28 also included changes related to the annual copay maximum (out-of-pocket maximum) for private plans.

 

New Pharmacist Acts

Since June 20th, 2015, pharmacists are entitled to offer seven new pharmaceutical services to the population and four are billable acts for private plans as outlined below:

  1. Extend a physician’s prescription for more than 30 days – If a patient has no more renewals, a pharmacist can, after evaluating the situation, extend the prescription.
  1. Schedule follow-ups with patients in order to achieve therapeutic targets – A pharmacist can take over prescription adjustments for some conditions when the physician has specified the therapeutic targets.
  1. Prescribe medication for some minor conditions when the diagnosis is known – A pharmacist can prescribe medication if the patient has already received a treatment for the condition in the past. The twelve minor conditions are:
    • Acne
    • Mouth sores
    • Eczema
    • Allergic conjunctivitis
    • Menstrual pain
    • Hemorrhoids
    • Labial herpes
    • Female urinary tract infection
    • Diaper dermatitis
    • Oral candidiasis due to inhaled corticosteroids
    • Allergic rhinitis
    • Vaginal yeast infection
  1. Prescribe medication when no diagnosis is needed – A pharmacist can prescribe medication for preventive purposes or when no diagnosis is needed for the following conditions:
    • Smoking cessation
    • Pregnancy morning sickness
    • Traveler’s diarrhea
    • Malaria prevention
    • Altitude illness prevention
    • Prenatal vitamins and supplements
    • Head lice
    • Emergency contraception

 

Further information is available at the following links and attachments:

Quebec Government

Great-West Life

Medavie Blue Cross

Sun Life

Category: Government Benefits, Legislative Updates