Insurer repayment cards

In Quebec, everyone must be insured: it’s the law. If your employer or that of your spouse does not have prescription drug insurance, you must register for the public prescription drug insurance plan.

Businesses that offer group plans retain the services of specialized firms to administer these plans. These firms let your pharmacist know, usually electronically, if your prescription is covered by your plan.

Remember that there are several types of plans, and your pharmacist does not know the details of your prescription drug insurance.

Present your card

Present your personal prescription drug insurance card at the same time as your prescription. This is especially important if it’s the first time you're doing business with a pharmacy. Why? Because if you present it after your order has been filled, the pharmacist will have to go back into your file in order to record your insurance information—and you’ll have to wait longer.

• If you do not have your card handy, you will have to claim your reimbursement directly from your insurer.
• If you get a new prescription drug insurance card with a new identification number, please notify your pharmacist. This applies to all members of your family, because pharmacists keep a record for each person. Don’t forget to present it before your prescription is filled out.

Deterrent fees, deductible, coinsurance

Insurers create their plans in many different ways.

• Some require partial payment for each prescription. These payments may take the form of deterrent fees or coinsurance. The amount payable might be fixed—$5 for example—or it may represent a percentage of the total prescription cost, i.e. 20%.
• Some plans require the payment of an annual deductible. You may have to pay the first $100 of prescriptions before your full coverage takes effect.
• Finally, it is not uncommon for plans to combine a deductible with coinsurance.

What is an uninsured surplus?

Some plans claim to provide 100% coverage of your medications. But this is not always strictly true. At checkout, it is possible that the pharmacist’s receipt will indicate an uninsured surplus that you must pay. This is a deterrent fee in disguise. Your insurer will cover the cost price of the medication, but not professional fees or other expenses such as the wholesale margin.

• If this happens, communicate directly with your insurer or your employer to remedy the situation. This tends to happen more frequently with insurers that are not based in Quebec.

Some medications cannot be claimed electronically

Insurer’s IT systems do not always allow you to submit claims electronically. Some drugs prepared by your pharmacist, such as creams, contain several ingredients and make online validation impossible.

• If this situation arises, your pharmacist will give you a receipt, and you must claim reimbursement of you prescription directly from your insurer.

In Quebec, patients have the freedom to choose

Unlike other Canadian provinces, Quebec pharmacists allow their patients to freely choose their pharmacist. This is a fundamental principle.

• Your insurance does not determine which health care professional will treat you.