On April 15, a law governing financial assistance for pharmaceutical companies through their assistance program came into force.
The wording is as follows:
Since April 15, 2021, manufacturers, recognized wholesalers or intermediaries are prohibited from paying or reimbursing, in whole or in part, to a person insured by the general drug insurance plan (RGAM), the price of a medication or supply whose payment is covered by this plan.
This regulation applies to a person insured with the RAMQ or with a group insurance or a private sector benefit plan, for a medication or supply whose payment is covered by the RGAM.
Therefore, for oncology, it is no longer possible to register a patient on a financial assistance program if the medication has a generic (Ex. Everolimus, abiraterone, …) or a biosimilar (Ex: filgrastim, pegfilgrastim) and this, regardless of the type of insurance of the person.
However, financial assistance programs remain possible for any medication of which only the original version is available and covered by the insurer.
Patients who already benefit from financial assistance in place can continue to receive it.
When a generic or biosimilar version of a product is added to the RAMQ list, or a medication becomes subject to the lowest price method (PPB), there is a period of 30 days before the financial assistance must be interrupted.
A Patient Support Program (PSP) is becoming a pathway to address the gaps in our healthcare system and other market complexities to commercialize pharmaceutical products and build brand equity.
Each program is designed to ensure that patients have timely access to the medications they need at the lowest out-of-pocket cost with quality care throughout their treatment. We can help you achieve this, healthcare professionals and patients.
The assistance programs managed by the RAMQ include, depending on the case, financial assistance or technical assistance. Some services or medications are also offered free of charge. Each program includes eligibility criteria and a procedure to follow.
For details on the reimbursement process for exceptional medications, visit the Reimbursement section.
The digital platform of RAMQ allows the community pharmacist to consult the status of a request for an authorized person.
The Status of a request for an authorized person allows the pharmacist to search for all authorization requests associated with an insured person (NAM) for a given medication. The search result displays the requests sent to the RAMQ by all prescribers and which were processed or completed in the last year.
