Group insurance plans in Quebec: new cost transfers from public to private plansLinkedIn
There, in black and white
NB Bulletin Vol. 17 N. 11, December 2014
Last week, the Quebec government tabled Bill 28 (An Act mainly to implement certain provisions of the Budget Speech of 4 June 2014 and return to a balanced budget in 2015-2016). Some provisions of this bill will directly impact the cost of group insurance plans in Quebec.
1st transfer: new medical acts performed by pharmacists
The bill specifies the new medical acts that pharmacists will be entitled to perform, such as renewing a prescription for certain drugs and prescribing drugs for certain conditions. It is the end result of Bill 41, which was tabled in December 2011 and was still in the analysis phase. Insurers are in the process of evaluating the potential reimbursement of fees charged by pharmacists in relation to these medical acts in private group insurance plans because, unlike physicians' fees, the RAMQ would not be responsible for pharmacists' fees. Insurers evaluate the cost of these potential new expenses, as well as the manner in which they would adjust their administration systems, which are not currently designed to reimburse these types of fees. Since the bill was announced, these reimbursements have also been the subject of negotiations between insurers, pharmacists and the government to determine appropriate fee levels for each service and whether the RAMQ or private drug insurance plans are responsible for these fees.
2nd transfer: the pressure on prescription drug costs
This same bill also stipulates that the public plan will no longer pay fees charged by pharmacists for certain procedures for individuals insured by the public plan. The government expects to save more than 130 million dollars by applying these measures, which is more than 10% of the total fees paid to pharmacists by the government. Historically, when their revenues were reduced by the government for individuals insured by the public plan, pharmacists tended to increase drug costs for individuals insured by private plans to offset their losses. The strong reaction of pharmacists to the government's announcement in the media last week could be an indicator of its potential impacts on private group insurance plans in Quebec.
How to protect against these transfers
Like insurers, the Normandin Beaudry consultants will be keeping a close eye on the situation over the next few weeks to see if the government will remain firm in its position when it comes to fees charged by pharmacists in the public plan and the introduction of new medical acts performed by pharmacists for which private plans are responsible. It is important to understand that the existing mechanisms for protecting private plans against a potential cost transfer from the public plan could be better adapted. This is something that must be examined, along with potentially revising some parameters of your group insurance plans. Insurers will also continue to put pressure on the government to avoid such a transfer. The mobilization of a larger number of plan sponsors may be necessary this time to avert the transfer scenario and avoid once again standing idly by and watching group insurance plan costs increase. We will keep you informed.
Please feel free to contact us for additional information.
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