Amount to pay for prescription drugs
You must tell your pharmacist who your insurer is. If you are registered with the public plan, you also have to present your valid Health Insurance Card and, if applicable, your claim slip (carnet de réclamation). When you purchase drugs covered under the public plan, you will generally pay only a portion of their cost: this is your contribution.
Your contribution toward the payment of public plan drugs
Each month, you contribute toward the payment of the covered drugs you purchase until you reach your maximum contribution. When you attain this amount, you can usually obtain other covered drugs free of charge until the end of the month. As a rule, your contribution includes the following amounts:
- A deductible: A set monthly amount of $22.25 that you pay through your first purchases of the month.
- Your portion of the co-insurance: An amount corresponding to 35% of the cost of covered drugs. It applies once the deductible has been paid, until you reach your maximum monthly contribution, if applicable.
The other portion of the co-insurance is paid by RAMQ, without you having to do anything. The rates for the deductible and co-insurance are adjusted each year on July 1. Certain persons are entitled to prescription drugs free of charge: they do not have to pay the annual premium, deductible, co-insurance and cost of prescription drugs.
Your contribution explained
|Prescription cost||Prescription drug cost + Pharmacist’s professional fee|
|− Contribution by insured person||Monthly deductible + Your portion of the co-insurance (until you reach your maximum monthly contribution)|
|= Amount to be paid by the insurer||Cost paid by RAMQ for prescription drugs covered by the public plan|
Example of payment of covered drugs at the pharmacy
Here is the breakdown of a $60 payment for a prescription at a pharmacy, at the time of your first purchase of the month:
For a total prescription cost of $60, you first pay the deductible of $22.25. Then on the remaining $37.75, you pay your portion of the co-insurance, amounting to $13.21. In the end, you pay $35.46 ($22.25 + $13.21) of the $60 invoice. These rates are in effect from July 1, 2021 to June 30, 2022 for adults age 18 to 64.
|- Deductible (set amount that you pay)||- $22.25|
|= Remainder to be paid||= $37.75|
You: $37.75 × 35% = $13.21
RAMQ: $37.75 − $13.21 = $24.54
Even if the deductible is $22.25, you do not have to pay this amount for your first purchase if the cost of your prescription is less. This means that, if your first prescription costs $8, the remainder of the deductible will be payable when you make your next purchases, if applicable.
Details of your invoice and contribution
By law, pharmacists must provide you with a detailed invoice, containing the following:
- Contribution by the insured person: Your contribution toward the payment of the prescription drug, if the pharmacist has this information. It includes the amount of the deductible and the amount of co-insurance.
- Prescription drug cost: Amount paid by the pharmacist to obtain the drug sold to you. It is the same for all pharmacies.
- Excess amount not covered, if any: Amount corresponding to the difference between the cost of a drug and the maximum amount covered by the public plan. For instance, you may pay an excess amount if you choose a brand name drug instead of a less costly generic version appearing on the list of covered drugs. The excess amount is not factored into the maximum monthly contribution.
- Pharmacist’s fee: Remuneration to cover the pharmacist’s professional services. Under the public plan, this is a set fee, determined by an agreement. However, for persons covered under a private plan, the fee may vary.
- Wholesaler’s mark-up: Amount corresponding to the percentage that a wholesaler is allowed to add to the selling price of a drug that it purchased from a manufacturer.
- Prescription cost: Total of the drug cost, pharmacist’s fee, wholesaler’s mark-up and excess amount, if any.
- Amount paid by the insurer: Amount paid by RAMQ, by a group insurance plan or employee benefit plan, if the pharmacist has this information.
- Total amount of the maximum contribution: Amount of the contributions paid to date and amount remaining to be paid before reaching your maximum contribution, if the pharmacist has this information.
- Total amount that you have to pay: Usually, the total of the deductible, co-insurance and excess amount not covered, if applicable.
- Reference number: Number assigned by RAMQ, by a group insurance plan or employee benefit plan.
Renewing a prescription before the expected date?
You pay your contribution (deductible and co-insurance) as if you had purchased your prescription drug on the expected renewal date.
Purchasing prescription drugs for more than one month?
You have to pay the deductible and co-insurance for each month’s supply billed in your purchase.
If you change insurers in the course of the year, you must avoid overpaying your annual maximum contribution. Your former insurer must give you a document that specifies the contributions that you paid for the current year. Certain insurers, including us, will do so automatically, while others will issue the document only on request. You must then provide this document to your new insurer, which will be able to take it into account in making sure your maximum contribution is not exceeded.
You may use the form Statement of Contributions if you change from a private plan to the public plan.
Persons covered free of charge
The following persons are generally covered by the Public Prescription Drug Insurance Plan free of charge:
|Holders of a claim slip (carnet de réclamation)||Hold a valid claim slip|
|Children of persons covered under the public plan|
Under age 18: Not have access to a private plan through a student job or otherwise
Age 18 to 25:
|Persons with a functional impairment|
|Persons age 65 or over||Receive 94% and more of the maximum Guaranteed Income Supplement|