Prescription drugs covered
Prescription drugs covered by the Public Prescription Drug Insurance Plan
The public plan Public plan
The Public Prescription Drug Insurance Plan is administered by the Régie de l'assurance maladie du Québec and is intended for persons who are not eligible for a private group insurance plan covering prescription drugs, for persons age 65 or over, and for recipients of last-resort financial assistance and other holders of a claim slip (carnet de réclamation). Children of persons registered for the public plan are also covered by that plan. administered by the Régie de l’assurance maladie du Québec covers drugs obtained on prescription in Québec and dispensed by a pharmacist. The drugs covered (over 8 000 of them) are listed on the List of Medications, published periodically by the Régie.
The Minister of Health and Social Services, in consultation with the Institut national d'excellence en santé et en services sociaux, determines which drugs to list.
For all prescription drugs, persons insured under the public plan are required to pay a contribution (deductible and co-insurance), and each purchase of a covered drug is taken into account to determine a person's maximum annual contribution.
The public plan covers, under certain conditions, those drugs listed in the "Exceptional Medications" section of the List of Medications.
Several exceptional medications are coded, which means that doctors enter a code on these prescriptions so that the drugs will be automatically insured. Insured persons with coded prescriptions may then go to a pharmacy and obtain the prescribed drugs.
In the case of non-coded prescription drugs, doctors must send the Régie a payment authorization request. Once authorization is granted, insured persons can obtain the prescription drugs at a pharmacy.
In its Statement of Services for the Public, the Régie undertakes to meet the following deadlines:
- 24 hours to respond to an authorization request for an exceptional medication considered urgent (these drugs are preceded by an asterisk in the List of Medications)
- 48 hours to respond to any other authorization request concerning an exceptional medication
Exception patient measure
For treatment of a serious medical condition, the exception patient measure may cover, on an exceptional basis, certain drugs, for instance, drugs not appearing on the List of Medications. In such cases, however, certain criteria must be fulfilled.
Your doctor must send the Régie a payment authorization request. Once authorization is granted, you can obtain the prescription drug at a pharmacy.
Application for review
If authorization is denied, you may ask your doctor to submit an application for review or do so yourself by writing to the Régie within 6 months following the decision notice date.
Please mail the letter, containing the new information to be taken into consideration, to the following address:
Régie de l'assurance maladie du Québec
Expertise professionnelle (pharmacie) Q040
Case postale 6600
Québec (Québec) G1K 7T3
Recourse with the Tribunal administratif du Québec (TAQ)
If you are dissatisfied with the decision following review, you can write to the secretariat of the Tribunal administratif du Québec within 60 days of the date of the review decision.
Prescription drugs obtained outside Québec
As a general rule, the public plan does not cover prescription drugs purchased outside Québec. Thus, persons who obtain their drugs outside the province are not entitled to a reimbursement from the Régie. When leaving Québec temporarily, it is wise to take out travel insurance covering prescription drugs.
However, there is an exception to this rule. The public plan does cover prescription drugs purchased at certain out-of-province pharmacies near the Québec border, but only if there is no pharmacy in Québec within a 32-kilometre radius. In addition, the pharmacy must have concluded an agreement with the Régie.
Drugs received during a stay in a hospital or in a longterm care facility
Prescription drugs received in Québec during a hospital stay or during a period of residence in a public or subsidized private longterm care facility Residential and long-term centre
A subsidized private residential and long-term care centre receives government grants and complies with standards in force in the public sector. A non-subsidized private residential and long-term care centre is independent of the public sector and it does not receive government grants. are covered in full by government hospital insurance.
Generally speaking, residents of non-subsidized private longterm care facilities pay a contribution when purchasing their prescription drugs.
Certain stop-smoking products are covered by the public plan. Like the other drugs listed on the List of Medications, they are covered only when obtained on prescription in Québec. In addition, coverage is limited (in terms of duration and in quantity).
Stop-smoking products covered are:
- skin patches;
- nicotine gum and lozenges;
- 2 types of tablets.
Duration of coverage
Skin patches are covered for a maximum of 12 consecutive weeks per 12-month period. During those 12 weeks, the plan reimburses a maximum of 840 lozenges or pieces of gum.
The 2 types of stop-smoking tablets are also covered for 12 consecutive weeks per 12‑month period, whether or not they are used at the same time as the nicotine patches and gum or lozenges. In the case of one of the types of tablets, coverage may be extended by 12 weeks, provided that you have stopped smoking.
Please note that the period coverage of stop-smoking products is calculated from the date you purchase them, not from the date you start using them.
Here is an example of how coverage of stop-smoking products works.
Reimbursement of stop-smoking products
Insured persons pay a contribution, just as they do for the prescription drugs covered by the public plan, according to the rates in effect.
Prescription drugs covered by private plans
Prescription drug coverage offered by private plans Private plan
Private plans are usually available in the form of group insurance or employee benefit plans. Persons may be eligible for a private plan through employment, through membership in a professional order or association, or through their spouse or parents. Persons who are eligible for a private plan are required to join that plan. may differ from one plan to another. However, all private insurers Insurer
A legal person that holds a permit issued by the Autorité des marchés financiers authorizing it to transact personal insurance in Québec and that assumes, in return for a premium paid, the financial consequences resulting from one or more risks specified in the contract signed by the parties. must cover at least the drugs listed on the List of Medications, which includes the exceptional medications and drugs covered under the exception patient measure.
As for stop-smoking products, ask your insurer or your employer about which products are covered and for how long.