Bill 92 Passed: Impacts on Group Benefits Plans

The Quebec government passed Bill 92 on December 6, 2016, which includes several measures that will affect group benefits plans.

Effective September 15, 2017, pharmacists will be required to issue itemized receipts listing their professional fees, the price paid by the Quebec’s basic prescription drug insurance plan for every medication and the wholesaler’s profit margin. Receipts currently indicate a total amount only. Once this information is available on receipts, it will be easier for plan sponsors to make members aware of drug prices, and thereby ensure better control of drug plan costs.

The act of directing a member to a specific pharmacy to obtain drugs or services, was discussed during the consultations held by the parliamentary committee. Following these discussions, a new amendment was added to the bill to prohibit plan sponsors or insurers from restricting beneficiaries’ freedom to choose a pharmacist. Severe fines, ranging from $10,000 up to $1,000,000, could be imposed for infractions. The scope of this clause has yet to be clearly established. Clarifications will thus be necessary to fully understand the limitations in implementing cost control measures already being used elsewhere in Canada.

In recent years, a number of manufacturers have been offering members rebates through loyalty cards. The new legislation imposes restrictions on the commercial practices of manufacturers and wholesalers, such as the reimbursement of a portion of the price of a medication covered by the Quebec’s basic prescription drug insurance plan. The many reimbursement programs offered by manufacturers could therefore disappear from the market in the coming months.

Bill 92 provides a framework for the different commercial practices relating to prescription drugs, increases some of the powers of Régie de l’assurance maladie du Québec and protects access to voluntary termination of pregnancy services.

In 2015, we informed you about some legislative changes pertaining to new services provided by pharmacists and the reimbursement of brand name drugs at the cost of the lowest priced generic equivalent. Please refer to our bulletin on the ten most important developments in drug insurance in 2015 for more information.

Since 2015, a group consisting of all insurers and around 50 private employers representing approximately 400,000 members in Quebec, and in which Normandin Beaudry participated actively, continued to lobby the Quebec government in support of more issues, including:

• a framework for pharmacists’ professional fees,
• transparency of pharmacists’ professional fees,
• additional management tools; and
• access to the benefits of government negotiations with pharmaceutical companies.

Although Bill 92 is a step in the right direction, several demands, such as a better matching of public plan and private plans drug costs, were not addressed. If we want the government’s next actions to continue to equally protect the interests of private plans and the public plan, the actual payers, plan sponsors and their members, must continue to be involved to express their views. Minister Gaétan Barrette pointed out on several occasions that the proposed amendments to the legislative framework are a response to the demands of insurers and plan sponsors.

It has become increasingly clear that the group of market intermediaries should adopt a common position to ensure the sustainability of drug plans.

Please feel free to contact us for additional information.