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August 2015

New Financial Parameters for the Quebec Prescription Drug Insurance Plan

On July 1 each year, the Régie de l’assurance maladie du Québec adjusts the financial parameters applicable to the public prescription drug insurance plan to take into account the increase or decrease in plan costs.

The table below presents the changes that will apply to all individuals covered under the public plan, with the exception of:

  • Individuals who receive prescription drugs free of charge (no premium or contribution):
    • holders of a claim slip (generally recipients of last-resort financial assistance);
    • individuals aged 65 or over receiving from 94% to 100% of the Guaranteed Income Supplement (GIS);
    • children under 18;
    • full-time students aged 18 to 25 who do not have a spouse and live with their parents.
  • Individuals aged 65 or over receiving less than 94% of the GIS who are subject to a reduced contribution.

As last year, all financial parameters have increased this year.

We would like to remind you that:

  • The annual premium is the amount paid by insured persons when income tax returns are filed in order to be covered by the public plan.
  • The deductible is a fixed amount that constitutes the first portion of the cost that insured persons must pay when purchasing insured drugs.
  • The copayment is the portion of the drug costs that insured persons must pay once they have paid the deductible. In other words, when a person’s drug costs exceed the deductible, the person pays a portion of the remainder.
  • The maximum contribution is the maximum annual amount that insured persons are required to pay per month and per year to obtain drugs covered by the the public plan. This maximum amount includes the deductible and the copayment.
Upward impact on private group insurance plan costs

Because private group insurance plans do not typically apply the same parameters or the same set of cost control measures that apply to the public plan, we do not anticipate important financial impact on private plans.

It should be noted that Bill 28, adopted on April 20, 2015, modifies the current legislative framework. You can consult the summary of the changes available in our May 2015 bulletin. Details on the application of some of these changes will be announced shortly. Watch our communications in the coming days for more information.

Cost control measures for private plans

Even though Quebec’s Act respecting prescription drug insurance includes rules to be followed for private plans, it is also possible to introduce certain cost control measures in relation to these plans. However, these measures call for a process with the insurer. We invite you to review a summary of our approach in controlling prescription drug costs (available in French only).

Please feel free to contact us for additional information.

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