Update on Québec's Economic and Financial Situation
INFORMATION BULLETIN
November 7, 2023
3. ADJUSTMENT OF THE EXEMPTIONS ALLOWED FOR THE PURPOSE
OF CALCULATING THE PREMIUM PAYABLE UNDER THE PUBLIC
PRESCRIPTION DRUG INSURANCE PLAN
2023-6
The basic prescription drug insurance plan established by the Québec government guarantees
all Quebecers fair access to the medications required by their state of health. Coverage under this
plan is provided either by the Régie de l'assurance maladie du Québec (RAMQ), as the
administrator of the Public Prescription Drug Insurance Plan (PPDIP), or by insurers transacting
group insurance or by administrators of private-sector employee benefit plans.
As a general rule, the RAMQ provides, on the one hand, coverage for individuals who are not
required to become members of a group insurance contract, an individual insurance contract
concluded on the basis of one or more of the distinctive characteristics of group insurance, 20 or
an employee benefit plan applicable to a determined group of persons and, on the other hand,
coverage for those persons whom no one is required to cover.
Adults registered with the RAMQ must make a contribution towards the payment of the cost of
pharmaceutical services and drugs supplied to them whenever a prescription is filled or renewed.
This contribution, which may not exceed a maximum amount, consists of a deductible amount21
and a coinsurance payment.22
However, adults whose income consists essentially of social assistance benefits based on an
examination of resources, needs or income are exempted from the payment of any contribution.
This exemption, which targets the most disadvantaged persons, is geared more specifically to
certain persons eligible for a financial assistance program stipulated in the Individual and Family
Insurance Act, 23
as well as persons aged 65 or over receiving 94% or more of the maximum
amount of the monthly Guaranteed Income Supplement under the Old Age Security Act24
determined without taking into account the amount that may be added to the amount of the
supplement since July 2011.
Adults who are not covered throughout a year by a group insurance contract, an individual
insurance contract concluded on the basis of one or more of the distinctive characteristics of group
insurance or by an employee benefit plan applicable to a determined group of persons must
generally pay a premium for that year to finance the PPDIP. For information purposes, for
the 2023 calendar year, the maximum premium payable is $720.50 per adult.
However, most adults who are exempted from the payment of any contribution for the cost of the
pharmaceutical services and drugs provided to them under the PPDIP are also exempted from
payment of the premium.
20
21
22
The individual insurance contract must be covered by section 42.2 of the Act respecting prescription drug
insurance (CQLR, chapter A-29.01).
The deductible amount is the portion of the cost of pharmaceutical services and prescription drugs borne entirely
by the person covered by the plan during the reference period. Since July 1, 2023, the deductible amount is
$275 per year, divided into equal monthly amounts.
The coinsurance payment is the portion of the cost of pharmaceutical services and medications borne by the
person covered by the plan until the maximum contribution is reached. Since July 1, 2023, the coinsurance
percentage is 33%.
23
CQLR, chapter A-13.1.1.
24
R.S.C. 1985, c. O-9.
12View entire presentation