In December 2004, the Minister of Health and Social Services of Quebec tabled a draft pharmaceutical policy with 34 proposals grouped under four objectives: accessibility of medication, fair and reasonable prices, optimal drug use, and a dynamic pharmaceutical industry in Quebec. Following a parliamentary consultation, Bill 130 amending the Act respecting prescription drug insurance and reflecting a number of these proposals was passed at the end of 2005. Though many provisions of Bill 130 are still not in effect, their real impact on private plans is unknown.

In general, the pharmaceutical policy measures enacted by Bill 130 will mostly benefit persons covered by the Régie de l’assurance maladie du Québec(RAMQ).

Although Bill 130 did not implement the proposal which would have set the generic drug price limit as a percentage of the initial brand name drug, it introduces various cost containment provisions. One is the possibility for the Quebec government to enter into risk sharing agreements with pharmaceutical companies for specific medications. These measures will likely have a limited impact on private plans sponsored by employers.

In fact, in Quebec, employees aged 65 and over have generally the choice to stay covered under the private plan sponsored by their employer or to opt for the RAMQ drug coverage. In the latter case, certain private plans cover the percentage that is not reimbursed by the RAMQ. Therefore, these new cost containment measures will only impact the private plans that cover the RAMQ co-payment.

Another Bill 130 measure with limited effect on private plans is the faster update process of the RAMQ’s drug list. It will require employers whose private plans cover a list of eligible drugs tied to the RAMQ drug list to update their list at a somewhat faster pace than before.

But certain provisions of Bill 130 could imply a cost transfer to the private plans. The Bill amends the Hospital Insurance Act and allows the government to determine the conditions in which a person in a hospital can be administered a drug they purchased externally. Prior to the adoption of Bill 130, a person would not be able to be treated in a hospital with medication purchased outside the hospital. This new change could mean that newer and more expensive drugs would be required to be purchased in community pharmacies with cost transfer to private plans.

An overview of the pharmaceutical policy measures introduced by Bill 130 indicates that they were not adopted with private plans in mind. Employers have in fact been excluded from the medication advisory panel established by Bill 130 called “Table de concertation du médicament.”

It is indeed unfortunate that plan sponsors who directly support at least 50% of the cost of private drug plans were not given an official seat at this panel to voice their considerations.

The absence of measures based on the four pharmaceutical policy objectives aimed directly at private plans suggests that the government does not yet see private plan sponsors as key stakeholders in the health sector. Most of Bill 130’s measures that have a direct impact on private plans only seem to add to the administrative burden of employers who administer them. In addition, Bill 130 reinforces the supplementary nature of the public plan by further limiting access to the RAMQ drug plan to only those who do not have access to a group private drug plan.

Hopefully, public consultations on Quebec’s health reform proposal will help the Quebec government realize that it is in its best interest to recognize employers as partners. The legislation that will be tabled following the public consultation will be a great opportunity for it to support employers by allowing them to participate in prevention and cost containment efforts.

Alain Robillard is a principal with Mercer Human Resource Consulting’s Health and Benefits practice in Montreal.