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: the amount not covered by RAMQ (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 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 |
|---|---|
| Amount to be paid by the insurer | Cost paid by RAMQ for prescription drugs covered by the public plan |
| Amount you have to pay | Monthly deductible + Your portion of the co-insurance (until you reach your maximum monthly contribution) |
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, RAMQ pays 65%, or $24.54, and you pay 35% (your portion of the co-insurance), or $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, 2022, to June 30, 2023, for adults age 18 to 64.
| Prescription cost | $60 |
|---|---|
| - Deductible (set amount that you pay) | - $22.25 |
| = Remainder to be paid | = $37.75 |
| Co-insurance | RAMQ: $37.75 x 65% = $24.54 You: $37.75 × 35% = $13.21 |
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.
Understand your pharmacy invoice
The cost price paid by the pharmacist excludes their profit margin and includes 2 elements
- Price of the prescription drug: actual price paid by the pharmacist for a prescription drug
- Amount paid to the distributor: amount set by the government and paid by the pharmacist for the supply of prescription drugs
Professional fees include the direct and indirect expenses associated with the pharmacist’s professional service and the maintenance of the pharmacy’s operations, as well as the profit margin.
This is the amount covered by the basic prescription drug insurance plan. Your insurer (RAMQ or private insurer) is required to cover it.
The total price is obtained by adding the cost price paid by the pharmacist and the professional fees. Certain pharmacies indicate Montant Rx on their invoice instead of Prix total.
This is the amount paid by your insurer: RAMQ or benefit plan. It must at least cover the price of the basic prescription drug insurance plan.
The contribution by the insured person is the amount you have to pay, which is the sum of the deductible and the co-insurance.
- Deductible: amount you pay through your first purchases of the month
- Co-insurance: amount not covered by your insurer that you have to pay
- To be paid: amount that combined the deductible and co-insurance
Persons covered free of charge
The following persons are generally covered by the Public Prescription Drug Insurance Plan free of charge:
- Holders of a valid claim slip (carnet de réclamation)
- Children of persons covered under the public plan:
- Under age 18, without access to a private plan
- Age 18 to 25, without access to a private plan, in full-time attendance at an educational institution, spouseless, domiciled with their parents or legal guardian
- Persons with a functional impairment specified in the Regulation respecting the basic prescription drug insurance plan which occurred before age 18, spouseless, domiciled with their parents or legal guardian, without access to a private plan, not receiving last-resort financial assistance with a claim slip (carnet de réclamation)
- Persons age 65 and over receiving 94% and more of the maximum Guaranteed Income Supplement
Change of insurers during the year
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.
Suggested document
You may use the form Statement of Contributions if you change from a private plan to the public plan.
Frequently asked questions
You may apply for reimbursement if you have had to pay for normally covered costs when purchasing prescription drugs, while you were eligible for the Public Prescription Drug Insurance Plan. The application for reimbursement is made to your pharmacist, under certain conditions. Refer to the webpage Request a reimbursement for covered drugs for more information.
All insurers are required to offer at least the same prescription drug coverage as the public plan. However, a private insurer may offer more extensive drug coverage.
Exceptional medications
If your prescription drug is recognized as an exceptional medication, it will be covered under the public plan. Your physician or pharmacist will have to apply for authorization or renewal.
If you buy several prescription drugs each month, the deductible is applied to the first drugs listed on the invoice. Therefore, if they are entered in a different order from the previous month, the amount paid for the same drug may vary. At the end of the month, you can check that your deductible has not exceeded $22.25.
If you purchase prescription drugs for more than a month, you must pay the deductible for each of those months as if you were purchasing it on the expected renewal date.
Other factors
Other factors may affect the amount you have to pay for your prescription drugs, including:
- Change of insurer (your coverage may differ from one insurer to another)
- Increase or decrease in your income
- Change in your employment status
- Change in your family situation, for example, new couple, child no longer considered a dependant)
Yes. You must pay the deductible and co-insurance for each month covered by your purchase at the time of purchase.
Yes. You must pay the deductible and co-insurance as if you were purchasing your prescription drug on the expected renewal date.