Better understanding your pharmacy invoice!
As of September 15, 2017, pharmacies are required to provide a detailed invoice for all prescription drugs purchased in Quebec. Here are a few explanations that will allow you to better understand the information provided on these invoices.
Cost price paid by the pharmacist:
Also called the cost of ingredients or price of the molecule, the cost price of every drug is the same at all pharmacies for those covered under private insurance plans.
Amount paid by the Insurer:
This refers to the portion reimbursed by your private prescription drug insurance plan. For example, if your plan reimburses 80% with no deductible, this amount would be 80% of the total price of the drug. However, the amount reimbursed may be less than the % in the contract if the professional fees charged by the pharmacist are deemed excessive based on the schedules of usual and customary (U&C) fees established by your insurer.
Cost price paid by the pharmacist + Cost price paid by the pharmacist to the wholesaler + Professional fees.
This amount may vary from pharmacy to pharmacy and differ for those covered under private insurance plan as opposed to the RGAM plan. These fees encompass all the other elements that make up the total price of the medication, i.e. dispensing fees, operating expenses and the pharmacist’s profit margin.
The price paid by the RGAM (Régime général d’assurance médicaments, the prescription drug insurance plan) corresponds to the price payable by the RAMQ (Régie de l'assurance maladie du Québec, the Quebec health insurance board) for the medication that private insurers are also required to cover. This price does not include professional fees, and applies only to the cost of the medication and the amount paid to the distributor. This price is the same for those covered under private plans and the public plan, with the exception of certain medications for which the government has entered into agreements that apply only to those covered under the public plan.
Cost price paid by the pharmacist to the wholesaler:
This refers to the wholesaler’s profit margin, and is the same at all pharmacies.
Total to pay:
This refers to the portion that is not reimbursed by your group insurance plan. It corresponds to the deductible and/or copayment indicated in the contract.
Important information for employers with employees in Saskatchewan
Implementation of a sales tax in Saskatchewan
Saskatchewan announced that provincial tax (PST) of 6% will apply to insurance premiums with some exceptions. On May 16, 2017, Saskatchewan Finance released further guidance in the revised Information Bulletin (IN 2017-07) “Provincial Sales Tax on Insurance Premiums”. For full details please refer to the bulletin, however here are the highlights:
- The effective date is August 1, 2017.
- Both Individual and Group insurance premiums are subject to the SK PST, with some exceptions.
- Administrative Services Only (ASO) arrangements are also subject to the SK PST.
The SK PST applies on Group insurance premiums payable, and related entirely to a coverage period on or after August 1, 2017 using the following criteria:
Employer Premiums – Employer premiums under group insurance are taxable depending on the place of employment, not on residency.
Employee Premiums – Employee premiums under group insurance are taxable depending on both the place of employment and residency. An employee must live and work in Saskatchewan for the employee premiums to be taxable.
Source : Sun Life Financial
Creation of a drug benefit program for people under 25 in Ontario
In its 2017 budget released on Thursday April 27, the Government of Ontario announced the creation of a drug benefit program for people under the age of 25.
This program, called ‘’OHIP+: Children and Youth Pharmacare’’, will come into effect on January 1st, 2018. It will be for everyone aged 24 and under in Ontario, regardless of family earnings or whether they already have private insurance.
The OHIP+: Children and Youth Pharmacare program will pay for the entire cost of prescription drugs covered by the Ontario Drug Benefit program, and no deductible or co-payments will apply.
Insurance companies are waiting to get more information on the program to determine the potential impact on the group insurance plans of participants who live in Ontario.
We will keep you informed of the details as they become available.
If you have any questions, please contact your dElta advisor.
Source: 2017 Ontario Budget
Accessory fees are abolished in Quebec
Did you know that, as of January 26, health professionals who offer services covered by RAMQ can no longer bill patients for these services or for fees accessory to those services?
Whether in a hospital, CLSC, medical clinic or pharmacy, if the service offered is required from a medical or pharmaceutical point of view and is part of the list of services covered by RAMQ, health professionals cannot bill their patients.
Since group insurance plans provide coverage in addition to the one provided by RAMQ, accessory fees now covered by RAMQ can no longer be reimbursed by insurance companies.
If you have been billed for accessory fees covered by RAMQ since the entry into force of the regulation, you can submit a request for reimbursement to RAMQ, with the detailed invoice and original proof of payment attached, to the following address:
Direction des affaires professionnelles
Régie de l'assurance maladie du Québec
Case postale 6600
Here are a few examples of what patients can no longer be billed for:
Ultrasound performed by a radiologist (as of December 29, 2016).
Blood or biological samples collected by a physician’s office employee (except for the transport of samples, fees subject to a maximum).
Basic radiology services provided in a medical imagery laboratory.
Eye drops of all kinds.
For a detailed list of what can or cannot continue to be billed to patients, click here.(available in French only)
A more detailed drugreceipt as of September 2017!
Effective September 15, 2017, Quebec pharmacists will be required to give their clients a more detailed receipt. The Quebec Government passed bill 921 on December 6, which includes provisions aimed at regulating commercial practices relating to prescription drugs. The pharmacist’s drug or supply receipt will have to include the following information: the price paid by the basic prescription drug insurance plan; the pharmacist’s professional fees; the wholesaler’s profit margin. . . .
This detailed disclosure already provided in other Canadian provinces helps, amongst other things, better control drug insurance plan costs. Based on more detailed information, consumers will be better equipped to make informed decisions on prescription drug consumption.
For any questions on this topic, don’t hesitate to contact your dElta advisor.
(1) An act to extend the powers of the Régie de l’assurance maladie du Québec, regulate commercial practices relating to prescription drugs and protect access to voluntary termination of pregnancy services