March 3, 2015

Pangaea Express: Quebec Do Not Substitute Policy

by Ghislain Gauthier, Director

The Québec Health Minister announced the abolition of the « do not substitute » policy that was used by physicians, honoured by Québec pharmacists and reimbursed by the RAMQ. This will take effect on April 24, 2015. For patients who are currently taking a drug under the « do not substitute rule », the Minister has allowed until June 1st for a transition. After, this date, the pharmacist will be required to dispense the least cost alternative interchangeable, unless the patient agrees to cover the price difference between the brand and the generic. Private payers will be free to determine their own policies for reimbursement of prescriptions with the “Do Not Substitute” order.

The Health Minister has however allowed for the following exceptions;
* Drugs included on Schedule 7 of the Québec list of drugs will be fully reimbursed. Typically, what is listed on schedule 7 are drugs with a narrow-therapeutic window and drugs that have a unique pharmacokinetic or pharmacodynamic profile that would put the patient at risk if they were switched to a generic version. Example: immunotherapy drugs.
* Clozapine
* If a patient has severe allergy to one or some components of drugs, which could put the patient at risk
* If the formulation of the drug (p. ex. liquid) is not offered by a generic version
Last year, the policy is estimated to have cost the RAMQ $80 million. The new policy is estimated to save the RAMQ $40 million for the first year of implementation.