Impact of Bill 28 on An Act Respecting Prescription Drug Insurance
On November 26, 2014, Quebec's Minister of Finance, Carlos Leitão, introduced 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. This bill amends, in particular, An Act Respecting Prescription Drug Insurance and the Health Insurance Act. The measures adopted in relation to this Act will have an impact on prescription drug prices and thus on group insurance policies.
- Amendment and impacts
- What is a generic drug?
- What is a generic substitution?
This law requires the insurer to reimburse at least 66% of the amount paid at the pharmacy, whether for a brand-name or generic drug. With the entry into force of Bill 28, La Capitale will reimburse prescription drug expenses based on the cost of the least costly generic drug, regardless of the amount paid at the pharmacy.
According to Health Canada, a generic drug is a copy of a brand-name product, known as the “reference product.” Generic drugs contain the same medicinal ingredients as the brand-name drug, and are considered bioequivalent to the reference product. There may be many generic versions of the same reference product.
To be approved by Health Canada, a generic drug must meet the same standards as the brand-name drug. The drug manufacturer must have a series of tests performed to demonstrate that every drug batch meets the federal guidelines for Good Manufacturing Practices. It is therefore incorrect to think that the generic drug is less effective than the brand-name drug.
For more information on generic drugs, go to:
The generic substitute can be applied in two ways:
1. Generic substitute
The reimbursement amount is calculated based on the lowest-priced equivalent, unless the attending physician indicates “no substitution” on the prescription. In such a situation, the pharmacist will indicate that the DIN is non-substitutable in the patient's file. Reimbursement is calculated directly based on the cost of the claimed drug.
2. Mandatory generic substitution
The reimbursed amount is calculated based on the cost of the lowest-priced equivalent even if the attending physician had indicated “no substitution” on the prescription.
With the “Mandatory generic substitution” option, an insured with a medical condition requiring the use of a drug other than the lowest-priced equivalent can ask to be exempted from the generic substitute.
To do so, a medical form from the insurer must be duly completed by the attending physician.