Changes to the out-of-pocket maximum and co-insurance amount in Quebec
The Régie de l’assurance maladie du Québec (RAMQ) announced changes to the Quebec drug insurance plan. These changes affect plan sponsors who provide drug coverage to plan members residing in Quebec.
Out-of pocket-maximum and co-insurance (effective July 1, 2025). RAMQ has increased the out-of-pocket maximum payable for plan members residing in Quebec, for drugs listed on the RAMQ formulary. They’ve also increased the minimum co-insurance amount.
Out-of-pocket maximum and co-insurance
The changes below were effective July 1, 2025.
Legislative changes |
Drug claims for Quebec plan members |
Increase in annual out-of-pocket maximum to $1232 from $1196. |
Drug claims for plan members residing in Quebec for drugs listed on the RAMQ formulary are subject to the new annual out-of-pocket maximum of $1232. |
Increase in co-insurance (amount RAMQ pays) to 70% from 68%. |
Drug claims for plan members residing in Quebec for drugs listed on the RAMQ formulary are subject to the new minimum co-insurance amount of 70%. |
We’ve updated our systems to reflect these changes. There will be no immediate rate adjustments due to the changes. We expect minimal impact to plan members and on claim experience.
Questions? We’re here to help.
Please contact your Sun Life Group Benefits representative.