Why Québec needs a universal public drug insurance plan
Québec’s basic prescription drug insurance plan, established by the Act respecting prescription drug insurance and administered by the Régie de l’assurance maladie du Québec (RAMQ), requires all Quebecers to belong to an insurance plan that provides drug insurance coverage.
If you have access to a group insurance plan that provides prescription drug coverage through your employer, your union or your professional order, you are required to join that plan, as are your spouse and children. Only people who do not have access to a private group insurance plan can register with RAMQ.1
You might be tempted to believe that universal pharmacare would therefore be redundant here because Québec’s system provides universal coverage. Think again! Unfortunately, our system is designed as a public-private partnership – that is, a hybrid system rather than a universal one. Let’s see what’s wrong with this picture.
First of all, the cost of prescription drugs at pharmacies is higher for people with private group insurance than for those covered by RAMQ. This is because pharmacists’ professional fees are regulated for people covered by RAMQ, but are not subject to any clear legal limit in the case of people covered by a private insurance plan. Rightly or wrongly, private plan members are made to pay the price for fees that are underestimated under the public plan. It would be much fairer – albeit more complicated – if pharmacists had to negotiate with the government for higher fees under RAMQ.
Moreover, premiums under private insurance plans are higher than the annual RAMQ premium. Under the APTS’s basic health insurance plan, members have coverage that is roughly equal to that of RAMQ, but they pay nearly twice RAMQ’s maximum annual premium ($648). The main reason for this disparity is that the premium for private group insurance plans is determined based on the risk category of the group of insured people, the higher cost of prescription drugs and a 9% tax. The insurer’s administrative costs also get added to the bill.
If you’re wondering whether the APTS could choose not to offer prescription drug coverage so that its members could register with RAMQ, the answer is no. In order to provide long-term disability coverage, life insurance, and health insurance with coverage for the services of health care professionals, the APTS is legally bound to provide drug coverage at least on a par with that of RAMQ.2
What impact would a system of universal pharmacare have on APTS members?
The idea of group insurance is to ensure that there is enough money to cover all the claims of the group of people insured. Since prescription drug coverage represents, on average, 85% of health insurance claims, it’s clear that universal pharmacare as proposed by the federal government would significantly lower your insurance bill!
All group insurance plans are subject to a steady increase in premiums. The share of the premium paid by the employer, and the group’s specific experience, can help to narrow the gap. But the fact remains that APTS health insurance premiums for 2020 were roughly 1.5 times higher than the 2010 premiums. For a family covered by the intermediate plan, for example, this increase amounts to an additional $1,000 per year. This substantial hike is due in large part to the spiraling cost of drugs, expensive new drugs coming to market, and an increase in the use of certain classes of drugs such as psychotropic medications. There is no indication that this meteoric rise in insurance costs will slow down.
Think of what the impact would be on the cost of your group insurance if prescription drugs were fully covered by the government, as they are in all OECD countries that have a public health and social service system.
Despite various tips for lowering the cost of insurance premiums, such as 90-day drug refills and the use of generics, rising drug costs continue to have a major impact on health insurance plans.
Pharmacare is THE solution for lowering your insurance premiums.
And that’s why the creation of a universal public drug insurance plan is one of our demands during the current provincial contract talks. We need to make the Legault government understand that the existing hybrid plan is a serious financial burden for public sector workers – one that grows heavier year after year. Together, let’s make it clear that pharmacare is necessary for all Quebecers!
1. People 65 years old and over can also register with RAMQ while carrying group insurance.
2. Sections 35 and 38, Act respecting prescription drug insurance, chapter A-29.01.