The Public Drug Insurance Plan

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There are two types of drug insurance plans in Quebec: a public plan and private plans.

The public plan is run by the Régie de l’assurance maladie du Québec (health insurance board), also known as the “RAMQ”. This article explains the public plan.

Private insurance companies offer private plans. For more information on private insurance, see our article Accident, Illness and Disability Insurance.

 

Registering for the Public Plan

To be part of the public plan, you must register for it through the RAMQ. Registration under the drug insurance plan is not automatic like it is for the general public health insurance plan.

You can register online or by phone. For more information, visit the RAMQ website.

Important! What happens if you don’t have a private insurance plan and you’re not registered under the public plan either?

First, you must pay for your medication. Later, after you register under the public plan, you can ask the RAMQ to reimburse the cost of any medication you bought in the previous three months.

Drugs Covered by the Public Plan

The RAMQ pays for medication that meets all these tests:

  • is on the list of prescription drugs covered
  • is prescribed by a doctor or other health professional
  • comes from a pharmacist

The public drug insurance plancovers over 7,000 prescription drugs. The RAMQ has a list of these drugs.

People Who Have Access to Drug Insurance

In Quebec, everyone must be covered by drug insurance, either through the public plan or a private plan.

The public drug insurance plan was created to fill gaps and make sure that everyone in Quebec has either public or private drug insurance.

Only the following people have access to the public plan:

1.      People Without a Private Plan

The public drug insurance plan covers people who don’t have access to a private plan. So, if a private plan is available to you, you must join it, at least for the part that covers drugs.

You might have a private plan through your employer, an association or a professional order that you, your spouse or partner, or your parent belongs to.

Important!  If you have a private plan, you must register your children and certain other people living with you who are 18 or over and have certain kinds of disabilities. (To learn more about this, see the section “Private plans” on the website of the RAMQ.) “You must also register your spouse and his or her children if they live with you, unless your spouse already has a private drug insurance plan.

2.      People 65 Years Old or Over

If you are 65 years old or over, you are free to join the public plan. But you aren’t required to join. If you are eligible for a private plan, or are already covered by a private plan, you have several options. For more information, visit the website of the RAMQ.

3.      People Getting Last-Resort Financial Assistance and People With Government-Issued Claim Slips

If you get financial aid from the government, you usually have access to the public plan. For more information, visit the website of the RAMQ.

4.      Children of People Eligible for the Public Plan

If you qualify for the public plan, then your children qualify for it as well.

Cost of Drugs

Annual Fee

Anyone registered under the public plan must pay a fee each year. The fee is called a premium. The amount of the premium is based on a person’s income. The premium must be paid even if the person doesn’t buy any drugs during the year. 

However, there are some exceptions. For example, children and students under the age of 25 don’t have to pay a premium.

Limit on Amount RAMQ Pays

People registered under the plan must still pay a portion of the cost of drugs they buy.

The other part is paid by the RAMQ, but only up to a maximum price that the RAMQ agrees to pay for each drug.

Therefore, if you buy drugs at a price higher than the maximum price covered by the Régie, you must pay the difference.

Important !
This article explains in a general way the law that applies in Quebec. This article is not a legal opinion or legal advice. To find out the specific rules for your situation, consult a lawyer or notary.

Articles in the category "The Public Health System"