Montreal – A coalition of seven Quebec unions representing over 365,000 public sector workers is calling on the provincial government to cap pharmacy dispensing fees charged to private insurance plans. The unions argue that escalating costs are making private insurance unsustainable for their members, prompting some to consider opting for the public plan, the Régie de l’assurance maladie du Québec (RAMQ).
The core of the issue lies in a disparity in fee regulation. While the RAMQ negotiates and caps the fees pharmacists can charge, private insurers do not have the same leverage. This results in significantly higher fees for those covered by private plans, particularly for specialized medications. According to the unions, this inequity is driving up the cost of group insurance and creating a financial burden for workers.
“The issue is really equity,” stated Roberto Bomba, treasurer of the Fédération interprofessionnelle de la santé du Québec (FIQ). “It’s not fair. The government is taking the liberty of capping pharmacists’ fees because otherwise there is no control measure. Well, he must cap it for the entire population.”
The FIQ’s analysis reveals the scale of the problem. The organization estimates that pharmacists’ fees represent $48 million annually for its 58,000 healthcare professional members. Had those fees been equivalent to those billed to the RAMQ, the savings would have been $22 million, translating to approximately $380 per worker per year. This highlights the substantial financial impact of unregulated fees on private insurance costs.
The call for action comes as a proposed amendment to Bill 15, currently before the National Assembly. The unions are urging the government to incorporate provisions that would grant it the authority to regulate pharmacy fees for private insurers, mirroring the existing control over RAMQ billing. They contend that such oversight is crucial for the long-term viability of both private and public drug insurance systems in Quebec.
The rising cost of prescription drugs and an increasing number of workers on prolonged absences also contribute to the overall increase in private insurance premiums. However, the unions emphasize that the disproportionately high fees charged by pharmacists to private plans are a significant and addressable factor.
The situation in Quebec is unique compared to other Canadian provinces. As highlighted in a report by Telus Health, pharmacist fees for prescriptions filled in Quebec under private plans averaged $19.49 – more than double the fees reimbursed by the RAMQ. This difference stems from the lack of provincial controls on fees billed to private insurers.
Several factors contribute to this disparity. Unlike other provinces, Quebec regulations require pharmacy owners to be pharmacists, potentially limiting competition. The Quebec Association of Owner Pharmacists (AQPP) also plays a role, with owner pharmacists required to be members and pay membership fees. The unions suggest that removing these restrictions could foster greater competition and drive down fees, aligning Quebec with the practices seen in other provinces.
The concerns extend to the costs associated with specialty medications. The unions report that fees for these drugs can exceed $50,000 per year for a single patient, further exacerbating the financial strain on private insurance plans. This is particularly relevant given the increasing prevalence of specialty drugs, which accounted for 35.1% of eligible drug spending in Quebec in , according to TELUS Health’s data. Recent data suggests this number climbed to 36.8% in .
Beyond the financial implications, the unions argue that the current system creates an unfair burden on workers and threatens the sustainability of group insurance benefits. They emphasize the need for a level playing field where all Quebec residents, regardless of their insurance coverage, have access to affordable prescription medications.
The organizations signing the letter urging government intervention include the FIQ, the Federation of Health and Social Services – CSN (FSSS-CSN), the Autonomous Federation of Education (FAE), the National Federation of Teachers of Quebec (FNEEQ-CSN), the Federation of Professionals (FP-CSN), the Union of Professionals of the Government of Quebec (SPGQ), and the Federation of Public Service Employees (FEESP-CSN). Their collective voice underscores the widespread concern over the escalating costs of prescription drugs and the need for regulatory reform.
A complaint filed by Beneva, an insurance provider, with the Competition Bureau Canada in , further illustrates the concerns surrounding pharmacy fees. Beneva alleges anti-competitive practices related to inflated professional fees charged by pharmacists, particularly within specialized patient support programs. This complaint highlights the broader issue of transparency and accountability in pharmacy billing practices in Quebec.
a recent legislative change, Bill 2, included a provision regulating the use of private agencies by pharmacies, a move initially requested by the AQPP. While welcomed by the AQPP, the inclusion of this provision in Bill 2 surprised the Quebec Order of Pharmacists and the Association professionnelle des pharmaciens salariés du Québec (APPSQ), who were not consulted during the legislative process. This underscores the ongoing debate and evolving landscape of pharmacy regulation in the province.
