💊 Financial assistance and reimbursement
⚖️ Regulations in force since April 15, 2021
As of April 15, 2021, manufacturers, recognized wholesalers or intermediaries are prohibited from paying for or reimbursing, in whole or in part, a drug or supply covered by the Régime général d’assurance médicaments (RGAM).
This prohibition applies :
- People insured by RAMQ,
- And to those covered by private or group insurance, for any product on the Drug Benefit List.
❌ Drugs not eligible for financial assistance
It is no longer possible to offer financial assistance for medication:
- Having a generic or biosimilar version (e.g. Everolimus, Abiraterone, Filgrastim, Pegfilgrastim),
- Regardless of the type of insurance the patient has (public or private).
✅ Permitted exceptions
Assistance may still be granted for :
- Drugs listed in Schedule V of the RAMQ List for which the Lowest Price (LPP) does not apply
(e.g. Leuprolide, Lithium, 5-ASA, Levothyroxine, Theophylline, Cyclosporine, certain insulins, Methylphenidate). - Drugs without a generic or biosimilar version registered.
- Prescription with NPS – Do not substitute with adequate justification.
- Cases where financial assistance was already in place before April 15, 2021.
⏳ When the drug becomes subject to SCH, a 30-day delay is allowed before assistance is discontinued.
🤝 Patient Support Programs (PSP)
PSPs can :
- Facilitate treatment initiation,
- Offer financial support,
- Help with compliance and follow-up,
- Offer personalized resources to patients and healthcare professionals.
Objective: to guarantee rapid access to treatment with minimal financial burden for the patient.
📑 RAMQ assistance
Some RAMQ programs offer :
- Financial or technical assistance,
- Free services or medication (according to eligibility).
👉 See Exception Drug Reimbursement for criteria and procedures.
🧾 For community pharmacists
The Patient and Exceptional Medicines platform enables :
- Consult the status of authorization requests,
- Search by name or NAM,
- And display all requests processed or expired in the last year.
