My invoice and the price of my medication
Here are the answers to your most frequently asked questions
Features of my invoice
They include four different components:
- Pharmaceutical evaluation: validation of the prescription, analysis of your patient file and counselling services
- Preparation and verification of the medication
- Professional responsibility for monitoring drug therapy throughout the course of treatment
- Operating expenditures *
* These are the pharmacy’s operating expenses, which enable it to deliver readily accessible, high-quality service, which includes extended opening hours. They include salaries, inventory costs, rent, computer equipment, specialized devices, electricity, and financial charges, among others. These are expenses that any business needs to cover.
Therefore, the professional fees that you see on the invoice do not represent the net profit or the owner-pharmacist’s salary.
It is important to note that both the cost price of the drug and the amount paid to the distributor, listed on the invoice, are the actual prices the pharmacist pays. Consequently, these amounts do not include a profit margin for the pharmacy.
The Act Respecting Prescription Drug Insurance now requires that the invoice patients receive from their pharmacist when purchasing medications on the Régie’s List include greater detail. It provides you with the same information as before, but in more detail.
It is the price covered by the RGAM for a given medication; it corresponds to the price payable by the RAMQ for this same medication, which private insurers are also required to cover. This price does not include professional fees, and applies only to the cost of the medication and the amount paid to the distributor.
The RGAM price may differ from the total price paid by the pharmacist in certain specific cases which are determined by the government. In such cases, the law provides that the difference be paid by the patient.
The price paid by the RGAM (Régime général d’assurance médicaments, the prescription drug insurance plan) corresponds to the price payable by the RAMQ (Régie de l’assurance maladie du Québec, the Quebec health insurance board) for the medication that private insurers are also required to cover. This price does not include professional fees, and applies only to the cost of the medication and the amount paid to the distributor.
The contribution of patients covered under the public plan, which includes the deductible and co-insurance, is set by the government, based on various criteria. For more information, you can reach the Régie de l’assurance maladie du Québec at 1 800 561-9749 or visit the RAMQ website at www.ramq.gouv.qc.ca.
The contribution of patients covered under a private plan is set by the insurer, based on the patient’s coverage plan. The pharmacist has no information on the provisions of the patient’s private insurance plan. For more information in this regard, the patient must contact his employer or his insurer.
In addition to the cost price paid for the drug, the pharmacist pays the distributor an amount set by the government for ensuring drug supplies. It does not include a profit margin for the pharmacy.
The cost price of the drug is the actual price the pharmacist pays. It does not include a profit margin for the pharmacy.
The invoice is subdivided into three components. The cost price of the medication paid by the pharmacist and the amount paid to the distributor (wholesaler) by the pharmacist are amounts that do not include any profit margin for the pharmacy. The third component is your pharmacist’s professional fees.
The price of my medication
Methods for calculating deductibles and co-payments vary between the public and private systems. They also vary from one private insurer to the next, and are based on the coverage provided by employers and insurers. As a result, it is normal for two patients covered by different insurers to pay different amounts.
For individuals covered under the public plan: The contribution from patients covered under the public plan, which includes the deductible and co-insurance, is set by the government, based on various criteria.
For individuals insured through a private plan: The amount payable for your prescription is determined by your insurer, based on your plan’s coverage. Professional fees are set by the owner-pharmacist based on the drug’s complexity and the specifics of a pharmacy’s business. The price of a given drug will be the same for all patients in the same pharmacy.
The law protects you: you have the right to choose your own pharmacist and no one can force you to switch pharmacies. If you are being pressured by a private insurer or by a benefits plan administrator to do so, the Régie urges you to report the situation. File a report with the RAMQ by phone or by mail:
418 528-5659 (Quebec City area)
or 1 877 858-2242 (elsewhere in Quebec)
Dénonciation – Régie de l’assurance maladie du Québec – Case postale 6600, dépôt Q086 Québec (Québec) G1K 7T3
Should you also wish to inform the AQPP of complaints you’ve submitted, please e-mail the information to: firstname.lastname@example.org
For your safety and for continuous and adequate monitoring of your treatment, it is strongly recommended that you always go to the same pharmacy. This allows your pharmacist to access all the information he recorded previously in your file, which in turn ensures he can provide the best possible monitoring of your drug therapy. As a result, he can take better care of your health.
Staying loyal to your pharmacist: a guarantee of health and safety.
It is normal for the price of a pharmacy’s services and products to vary from time to time. This is the reality of an economic system in which competition comes into play and operating costs vary from one pharmacy to another. As detailed on the invoice, the total price includes a number of components. A pharmaceutical company or other stakeholders may sometimes make adjustments to a given drug’s cost. Fees may also vary due to additional expenses the pharmacist might need to shoulder to offer his services or simply due to inflation.
In addition, we’ve been seeing a change in the community pharmacy environment, especially over the last several months. These changes may affect a pharmacy’s business model and the cost of drugs. As such, it is normal for price variations to occur.
The public plan rates are set by the government and are not representative of the pharmacy’s operating realities because they have not been indexed to inflation in the past 15 years, even though the pharmacy business and the drugs themselves have become considerably more complex. Public and private plans are very different. For privately insured individuals, the fees reflect the pharmacy’s business conditions and the expenses required so it can remain accessible to its patients. The administrative and logistical management resulting from the multitude of existing private insurance plans generate a greater workload for the pharmacy staff as well.
Fees are established based on the pharmacy’s business conditions and the expenses it must shoulder to remain accessible to its patients and continue delivering high-quality services. Moreover, the varying level of complexity of the professional monitoring associated with each drug may influence professional fees.