Impact of Quebec's Bill 28 on prescription drug plans
This communication applies to all plan sponsors with plan members in the Province of Quebec
On April 21, 2015, the Quebec government sanctioned Bill 28, An Act mainly to implement certain provisions of the Budget Speech of 4 June 2014 and return to a balanced budget in 2015-2016.
About Bill 28
This bill was initially tabled in the fall of 2014. In light of the probable impact of the Medications and pharmaceutical services section of Bill 28 on the Act respecting prescription drug insurance and, in turn, on private drug insurance plans, a group consisting of representatives from a number of private insurers tabled a brief and appeared before the parliamentary committee at the special consultation on January 28, 2015. Robert Dumas, President, Sun Life Financial, Quebec, was one of the members of that group.
The government analyzed the proposals submitted by the various parties before passing Bill 28 in the National Assembly on April 20, 2015. Despite passing the Bill, some details remain unknown and will be confirmed as the government approves regulations associated with the Bill.
The private insurers’ group has made 5 recommendations in its brief. For the following 3 recommendations, the government is proposing the amendments described below:
- Reimbursement for brand-name drugs where a generic exists
- As is the case elsewhere in Canada and with RAMQ, for brand-name drugs for which a generic exists, private plans in Quebec will be able to limit reimbursement to the lowest cost (i.e., the cost of the generic equivalent).
- In the future, where a plan provides for generic substitution, it will no longer be mandatory for brand-name drugs to be reimbursed at 67.5% of the amount submitted; reimbursement will take place based on the lowest cost.
- Consequently, this will mean a change, effective October 1, 2015, in the way certain medications are reimbursed under plans that provide for generic drug substitution (either simple or mandatory).
- Services rendered in pharmacy (For more details on the services that could be recognized following the passage of Bill 28, please see Appendix A of this communication.)
- Only some new services rendered in pharmacy will be remunerated. The Bill does not specify which services are remunerated and we will need to wait for the disclosure of the regulations to know more.
- Services that are not remunerated will not be billed to the plan member.
- Reimbursement for these services will be included under Quebec’s Act respecting prescription drug insurance, but we still have to determine:
- The reimbursement level, and
- The parameters of the plan
- Confidential listing agreements with manufacturers
- The Quebec government is giving its approval to confidential listing agreements with manufacturers.
- Under such agreements, the negotiated medication will temporarily be taken out of the RAMQ formulary and will not be covered under private plans. Once the agreement is formalized, the negotiated medication is then listed on the RAMQ formulary and is covered by private plans.
- It appears that the negotiated cost savings will not apply to private plans, but more details on how this measure will be implemented and how it will impact private plans will follow.
In regards to the other 2 recommendations by the private insurers’ group, the government did not come forward with any possible solutions but seems to have heard our message:
- Detailed billing in pharmacy (transparency)
- The government did not formally adopt the insurers’ recommendation with regard to detailed billing.
- However, Bill 28 includes two amendments to existing clauses, which seems to indicate the will to allow for better drug claim cost control.
- We remain open to future discussions with representatives. Details to come.
- Drug price differentials between private plans and the public plan administered by RAMQ
- On this issue, the message from insurers about the sustainability of plans in Quebec seems to have been heard.
- Thus far, the government has not come forward with any possible solutions. However, Bill 28 includes two amendments to existing clauses, which seems to indicate the will to allow for better drug claim cost control for private plans: the Minister will present a report on private plans cost control on October 1, 2017 at the latest. We remain open to future discussions with representatives. Details to come.
What is the impact on Sun Life Financial’s prescription drug plans?
The time period specified for the coming into force of the provisions of the Act is 60 days following the assent, which means that any changes will take effect around June 19 or June 20, 2015, or in the case of the reimbursement of brand name drugs where a generic exists, the effective date will be October 1st, 2015. In the weeks ahead, Sun Life Financial will be evaluating the changes that will be required in order to ensure compliance with the new provisions of the Act.
For more information about Bill 28, visit the website of the National Assembly.
Please contact your Sun Life Financial Group Benefits representative.
The services previously framed under Bill 41 in 2013 that could be recognized following the passage of Bill 28, and the new professional activities pharmacists in Quebec will be authorized to carry out are as follows:
- Renew a physician’s prescription
- Prescribe a medication when no diagnosis is required
- Prescribe laboratory analyses in a community pharmacy
- Adjust a physician’s prescription
- Modify the form, dosage or quantity of a prescribed medication
- Modify the dose of a prescribed medication to achieve therapeutic targets
- Modify the dose of a prescribed medication to ensure the safety of the patient
- Substitute for the prescribed medication another medication from the same therapeutic subclass, in case of a complete supply shortage in Quebec
- Prescribe medication for a minor condition (where the diagnosis and treatment are known)
- Administer a medication in order to demonstrate proper usage