Quebec offers lessons in universal prescription drug coverage, finds report

The notion of a national, all-public pharmacare program in Canada continues to enjoy popular support. But when it comes to prescription-drug coverage, one province shows that there may be some merit to be had from not excluding private insurers.

In a new report, Fraser Institute Senior Fellow Yanick Labrie laid out the case that Quebec’s general drug insurance program, RGAM, has provided generally positive results in improving access to prescription drugs when compared to those of other provinces.

Under the public plan, social assistance recipients and people who are at least 65 years old are provided with a minimum level of coverage for the cost of pharmaceutical services and medications. Individuals who are not eligible for a private group insurance plan with an employer are also provided for in the public plan. Those who qualify for coverage under an eligible private group insurance plan are mandated to join.

“Around 4.7 million people belong to a private group insurance plan, or about 57 percent of Quebec’s population,” Labrie wrote. While the coverage of private group plans must at least equal that of the public plan, they can be expanded — and most are — to cover drugs that it doesn’t include.

In June 2018, 25.6% of all medicines approved by Health Canada between 2008 and 2017 were reportedly listed in the drug formularies of provincial public plans other than Quebec. Quebec’s public plan, meanwhile, covered 33.4% of those approved drugs.

Quebec also has an edge when it came to the speed of drug coverage approval, Labrie said. Over the last 10 years, he said the average time for a Health Canada-approved drug to be added to RGAM’s list of covered medications was 477 days. All public plans in Canada, on the other hand, had an average time-to-approval delay of 674 days.

Quebec’s government also reportedly maintains a less restrictive formulary compared to those in the rest of the country — it includes 8,000 prescription-drug products versus 4,400 on the Ontario Drug Benefit formulary — which offers patients and prescribers more options.

“Empirical evidence shows that it is first and foremost Quebecers with chronic and generally poorer health conditions who have benefited the most from Quebec’s approach towards universal drug coverage, in terms of improved access to needed medications and better health outcomes,” Labrie said.

He also highlighted RGAM’s unique feature of limiting catastrophic drug expenditures for both public and private plans’ beneficiaries, with just 0.2% of households in Quebec having to take on catastrophic pharmaceutical expenses over the course of a year. While pharmaceutical expenditures have risen, the use of other health services has undergone a relative decrease, possibly due to the preventive effects of timely pharmacologicl therapy.

“As a result, Quebec has the lowest total health spending per capita of any province in Canada,” Labrie said. “Clearly, a mixed universal public-private system like the one in Quebec, partly based on mandated benefits, deserves more attention in the current discussions of a proposed reform of the pharmacare system in the country.”