Québec - Bill 130

"An Act to amend the Act respecting prescription drug insurance and other legislative provisions"

On November 11, 2005, Bill 130 was tabled by the Québec Minister of Health and Social Services. It follows a public consultation on the Québec Drug Policy (Politique du médicament) presented in December 2004. It introduces several changes in pharmaceutical policy and in the way prescription drug insurance is administered in Québec. The following present the major points of the bill.

1. Bill 130 gives the Minister of Health and Social Services the power to make agreements with drug manufacturers on financial risk sharing for specific medications and on compensatory measures. It states that amounts received under these agreements may be paid into the prescription drug insurance fund.

Brogan Inc. comment: This will legitimize the ability of the Ministry of Health to enter into risk-sharing agreements with manufacturers with respect the listing of new drugs in return for certain undefined commitments. It would appear that the Minister will be able to delegate this responsibility to ministry officials and avoid the time consuming requirement of obtaining Cabinet approval.

2. Bill 130 requires that drug manufacturers and wholesalers establish rules to govern their commercial practices and gives the Minister the power to establish such rules if they fail to do so among themselves. In particular, if, after an investigation, it is believed that a pharmacist has received rebates, gratuities or other benefits not authorized by regulation for pharmaceutical services or medications, the government may deduct an amount corresponding to the value of these rebates, gratuities or other benefits from the payment for those pharmaceutical services or medications or obtain the reimbursement of that amount by way of compensation or otherwise, as the case may be.

Brogan Inc. comment: This will impact the promotional practices of manufacturers providing substantial amount of free goods to pharmacies. This could have a detrimental impact on pharmacies across the country and could ultimately lead to considerable pressure on the provinces to increase professional fees. It should be noted that, although it is absent from Bill 130, the government previously stated in the Québec Drug Policy that it intends to decrease the list price of the first generic from 70% to 60% of the brand price, and subsequent generics from 63% to 54%.

3. The bill states that medications are to be supplied free of charge to seniors receiving the maximum amount of guaranteed income supplement.

Brogan Inc. comment: Previously, the beneficiaries had a maximum monthly contribution of $16.66 with an annual maximum of $200.

4. The proposed legislation would simplify the implementation of amendments and corrections to the list of medications by allowing that they be published on the website of the Régie de l'assurance maladie du Québec.

5. The bill introduces a number of measures to promote the optimal use of medications. More specifically, it establishes a medication advisory panel which is composed of representatives of the ministry of health, the RAMQ, beneficiaries, professional associations (physicians, pharmacists), medical, pharmacy and nursing faculties, the insurance industry, the brand pharmaceutical industry and generic manufacturers. Its mandate pertains to advising the council (Conseil du médicament), notably in regards to risk sharing agreements with the industry.

The bill gives the council the authority to obtain non-nominative information from the Régie de l'assurance maladie du Québec about the medications supplied to persons covered by the public plan or by a private plan, including the therapeutic intent, if specified.

Brogan Inc. comment: What is interesting is the proposal to obtain private drug plan data. The legislation does not provide details about how this will be done, either constitutionally or practically. However, the authority for the government to demand data from private insurers is contained in Bill 83 "An Act to amend the Act respecting health services and social services and other legislative provisions."