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January 2021

Rates for Quebec’s prescription drug insurance plan for 2021

Every year on July 1, the Régie de l’assurance maladie du Québec (RAMQ) adjusts the rates for the public prescription drug insurance plan to take into account the increase or decrease in plan costs.

In our bulletin from July, we explained that the financial pressures caused by the COVID-19 situation in Quebec had prompted the RAMQ to set rates below what was expected based on the evolution of the plan’s costs. At the time, the RAMQ reserved the right to review rates as of January 1, 2021, rather than wait until July 1, 2021, as expected.

CHANGES FOR 2021

The table below presents the changes that apply to all individuals covered under the public plan, with the exception of those who receive prescription drugs free of charge (no premium or contribution):

  • holders of a valid claim slip (generally recipients of last-resort financial assistance)
  • individuals ages 65 or older receiving 94% to 100% of the Guaranteed Income Supplement (GIS)
  • children under age 18
  • full-time students ages 18 to 25 who are spouseless and live with their parents
  • individuals ages 65 or older receiving less than 94% of the GIS who are subject to a reduced contribution
OBSERVATIONS

The RAMQ is reversing the increase in co-insurance. Based on the mechanisms used to determine the rates, the RAMQ should have increased the co-insurance to 40%. Instead, it decided to use a rate of 35%. This decrease will offset the increase in the maximum annual premium and the monthly deductible, which will mitigate the financial impact for plan members as of January 1, 2021. An improvement in the plan’s perceived value should appeal to members, for whom the primary rate taken into consideration remains the co-insurance.

As a reminder:

  • The annual premium is the amount paid by an adult 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 an adult must pay when purchasing covered drugs.
  • The co-insurance is the portion of the drug costs in excess of the deductible that an adult must pay.
  • The maximum contribution is the maximum amount that an adult is required to pay per month and per year to obtain drugs covered by the public plan. This contribution includes the deductible and the portion of the co-insurance.
IMPACT ON PRIVATE GROUP INSURANCE PLANS

Because private group insurance plans do not typically apply the same rates or set of cost control measures as the public plan, no significant financial impact on private plans is expected. However, plans that apply the same rates as those used by Quebec’s public drug plan may benefit from a slight increase in costs.

For more information on this subject, please contact a Normandin Beaudry consultant.