Due to recent regulatory changes in Quebec, RAMQ will begin to pay for some pharmacy services effective immediately.
Some services that remain covered by Group plans will now be covered at 100% coinsurance, regardless of the level of reimbursement provided for in their plan. See below for the list of these services in addition, the list of new pharmacy services now covered.
Services covered 100% by private plans
· Change in drug therapy
· Therapeutic substitutions
· Post hospitalization care management service (New)
· Prescription of a drug
· Administering a drug to demonstrate its appropriate use
New services now covered by the RAMQ
· Emergency administration of certain drugs
· Initiation a drug therapy (including emergency oral contraception)
· Adjusting medication to meet therapeutic goals
· Modification of a drug therapy
· Assessment to extend a prescription and its extension
· Palliative care management service
· Request a consultation with another health professional
RAMQ is responsible for the sound management of the Québec Health Insurance Plan and of the Public Prescription Drug Insurance Plan. As part of its mission, it manages the eligibility of persons for the plans, monitors the remuneration of health professionals and facilitates access to health care.
Every year, the Quebec Drug Insurance Pooling Corporation (also referred to as the Société
de compensation en assurance médicaments du Québec) revises the Quebec group
insurance pooling terms and conditions.
All group insurers in Quebec contribute to a pooling plan that protects private sector plan
sponsors against the financial impact of large claims for drug costs. Based on pooling results
for previous years, the Quebec Drug Insurance Pooling Corporation submitted a report to
Quebec’s Health and Social Services minister. The report details 2021 pooling parameters
and has been approved by all industry members.
The new pooling levels and fees will be applied to renewal calculations that involve Quebec plan members.
Sanofi Canada’s 2020 healthcare survey regarding health benefit plans has been completed. Sanofi Canada surveys both plan members and plan sponsors. The survey took place in January/ February of 2020 and while it was conducted before the COVID-19 pandemic, many highlights remain relevant.
Wellness ranked high as an important factor when deciding on a job offer or remaining at an organization. 75% of plan sponsors planned to invest in health and wellness areas outside of the benefit plan in the next 3 years. This included mental health, prevention of illness/ management of chronic health conditions, physical fitness, social and financial well-being.
Pre-pandemic, mental health was an important focus for plan sponsors and this will be even more so now, as stress associated with the COVID-19 pandemic affects employees. The survey found that younger employees reported higher levels of stress and they are more likely to require time off from work as a result.
Adding Flexibility to Health Plans
82% of plan members would like to have a health spending account as part of their health benefit plan. Both plan members and plan sponsors are interested in greater flexibility from their health plans.
Focussing on Non-adherence to Prescribed Medicine
If employees are not taking their prescribed medication or not taking it correctly, it can have significant health consequences. Many plan members would prefer to use virtual care to renew prescriptions. It is easy to see how even more people would prefer to renew prescriptions virtually during the COVID-19 pandemic. Many insurance providers also have initiatives that support adherence that members and plan sponsors can take advantage of.
Virtual Health Care
When the survey was taken 71% of plan members were interested in using virtual care technology to receive healthcare services. It is easy to imagine that this number would increase with the current COVID-19 pandemic situation.
The 2020 Sanofi Canada healthcare survey offers interesting insight into what both plan members and plan sponsors are looking for from their group benefit plans. You can read the detailed report at Sanofi Canada
The Coronavirus is causing uncertainty for both employers and employees. Employers need to help their employees through this difficult time and there are steps they can take to support workers.
Plan for absences
It is possible that some employees may become sick, and even more will be worried and wanting to self-isolate. Employers need to consider employees who cannot work because they are in quarantine or who are not able to work as they need to care for others for example due to school closures.
While it may not work for all organizations, employers should consider work from home options for employees whenever possible. Employees also need to be secure in knowing they are able to take sick leave without financial hardship. The federal government has promised to provide changes to EI to support workers through this.
Offer Virtual Health
Now is the time to invest in employee health and wellbeing. It is natural that employees are experiencing higher levels of anxiety and depression in this time which can affect productivity. Virtual health care can support employees while reducing the strain on the health-care system as virtual health does not require employees to visit the doctor in person.
Virtual health-care benefits are critical at this time. In a recent survey, Mercer found 70 per cent of emergency room visits could be replaced with virtual consultations without any reduction in quality of care. (source: Benefits Canada )
It is vital that employers provide frequent updates to employees as employees look to their employer as a trusted source of information.
Providing information on services available to employees, for example how to access their Employee Assistance Program or other policies that support employees during this time is helpful.
Coronavirus has created significant economic uncertainty. Those close to retirement will be worried about their investments as they see the news coming from the financial markets. Employers can help employees feel supported by providing communications around financial wellness.
The most important thing employers can do is to communicate to their employees what actions they have taken to support them and keep them updated. This will help employees feel supported by their employer during this time.
Coronavirus (COVID-19) is a flu-like virus identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China and since reported in cities around the world. New cases are emerging globally. For your reference, we have attached the Getting Your Workplace Ready for COVID-19 communication from the World Health Organization. This information can be found at: https://www.who.int/docs/default-source/coronaviruse/getting-workplace-ready-for-covid-19.pdf
Every year, the Quebec Drug Insurance Pooling Corporation (QDIPC) reviews the terms and conditions for the high-cost pooling system in the province. Based on its latest review, QDIPC is revising its pooling levels and fees for 2020 to reflect trends in the volume of claims submitted to the pool, particularly catastrophic claims.
The new pooling levels and fees will be applied to renewal calculations that involve Quebec plan members.
A recent decision by the Ontario Divisional Court has outlined that an employer’s duty to accommodate ends when an employee’s disability becomes permanent and as a result, the contract of employment cannot be upheld.
The case – Katz v. Clarke
Mr. Clarke (the employee), was employed as a Front Store Manager at a pharmacy owned by the Katz Group (“Katz”) where Mr. Clarke had been employed for approximately 13 years at the time of termination. However, he had been off work on a leave of absence for over five years.
Mr. Clarke had been approved for short-term disability, followed by long-term disability.
Great-West Life (the disability insurer) advised the employer (Katz) that based on medical information, Mr. Clarke was not able to perform the essential duties of his position and there was no reasonable expectation that he would be able to perform them in the foreseeable future. Based on this, Katz advised Mr. Clarke that his employment had been frustrated due to his prolonged absence from work, his inability to perform the duties of his position and the lack of reasonable expectation that he would be able to return to perform the duties of his position in the foreseeable future.
Mr. Clarke’s legal counsel advised the employer that Mr. Clarke was “working very hard to get well so that he can return to his former employment and perform the essential duties of his position”, the employer provided Mr. Clarke with the opportunity to provide updated medical information outlining his projected return to work date. Mr. Clarke failed to provide this information and Mr. Clarke’s employment was terminated due to frustration of contract.
Mr. Clarke commenced an action against Katz of wrongful dismissal and damages under the Ontario Human Rights Code. Katz moved for summary judgement to have the claim dismissed. The motion judge dismissed this motion for summary judgement.
The motion judge noted that Katz was aware of Mr. Clarke’s desire to return to full employment and it was arguable that Katz’s failure to spend time and effort to explore with Mr. Clarke how his desire to return to work could be accommodated resulted in a “rush to judgment” that breached the Code.
Katz appealed the decision to the Ontario Divisional Court.
The Ontario Divisional Court overturned the decision of the motion judge, saying that an employer’s duty to accommodate is only triggered when an employee informs an employer not only of their wish to return to work, but also provides evidence of their ability to return to work. The Court also confirmed that an employer’s duty to accommodate ends where the employee is no longer able to fulfill the basic obligations of the the employment relationship.
When the employee’s disability is permanent, the employment contract is impossible to uphold and is therefore frustrated. However it can be noted that in this case the employer was successful in establishing frustration of employment after the employee had been absent from work for more than five years.
We are very pleased to be working with Advica Health to provide virtual health and healthcare navigation. Please contact us for more information. Advica Health’s informative newsletter on the topic of substance abuse is below.
Substance Abuse: A Serious Health Concern That No One Talks About:
Studies are showing that alcohol, pills, recreational drugs, and
in a lot of cases a combination of different substances, are omnipresent
problems among the population, especially among youth.
There’s a lot of buzz about these issues, but rarely anyone seems
to be doing anything of huge value to stop or prevent substance abuse. What’s
more, quite a lot of people are not aware that this widespread problem is
actually a type of mental disorder.
Why this lack of social consciousness? It mainly has to do with
how people actually perceive mental disorders. When one says “mental
disorder/illness”, a great number of people instantly think “mad” or
“disturbed,” painting a mental picture of someone who’s not exactly in their
This couldn’t be further from the truth. While there are severe mental
disorders that significantly affect one’s behavior, and even rational thinking,
the definition of mental disorder actually refers to all conditions that
negatively affect one’s mood, behavior, and thinking. This includes depression
and anxiety. As well as substance abuse.
How Are Substance Abuse and Mental Health Connected?
Substance abuse and mental disorders are very closely related, but
one doesn’t necessarily cause the other. If a person has any kind of mental
illness, it doesn’t mean that they are definitely going to start drinking or
However, drinking a lot and using drugs may increase the risk of
underlying mental disorders. They may also worsen an existing mental health
issue. And, of course, if someone already has a mental health disorder, they
often do abuse various substances to self-medicate, and try and cope with the
So, it all comes down to both genetics, as well as the way someone
thinks and feels. If they perhaps feel depressed, or they’re already at risk of
developing any other mental health issue, they turn to substance abuse to
alleviate the symptoms. However, they often fall down the rabbit hole and make
things worse, even triggering new symptoms.
What Drives Substance Abuse?
There are many causes of substance abuse, but the greatest one
seems to be genes. Genetic factors account for 40-60% of a persons’
vulnerability to drug addiction, so genetics has a huge role to play in this.
Other causes include family or relationship problems, stress,
depression, anxiety, bipolar disorder, chronic pain, problems with sleep, poor
financial situation, a family history of mental disorders or addiction,
traumatic experiences, neglect, or abuse.
Furthermore, there’s peer pressure, which has always been a quite
common factor contributing to substance abuse. If a person wants to fit into a
friend group, and feel accepted, they may give in to peer pressure, and start
using drugs or alcohol.
Last but not least, there’s the desire to try something new, to
experiment. But just like all these other causes, this one too comes from a
place where a person is suffering for any reason and wants to deal with the
problem using various dangerous substances.
Call it escapism, if you will, but it definitely isn’t a way
out! It makes both mental health and physical health worse, and it’s a
problem that should be effectively dealt with.
Warning Signs of Substance Abuse
If you’re ever worried that someone you know may have turned to
alcohol or drugs for any reason, you should be able to spot the warning signs,
so that you can actually help them. The most common telltale signs of substance
abuse may include:
Drastic changes in behavior (impulsive, volatile, angry)
Sudden mood swings and irritability
Sudden hyperactivity and euphoria
Lack of motivation, energy, and interest
Excessive and loud talking or trouble talking
Sudden weight loss or weight gain
Changes in sleep patterns
Twitching or excessive sweating
Deterioration of hygiene
Difficulty concentrating and coordinating
Anxiety and paranoia
Contracted or dilated pupils
Watery or glassy, red eyes.
There are definitely more warning signs that you could spot, but
you definitely couldn’t miss any of these. They differ from one substance to
the next, but being aware of all these will absolutely help you gain a much
clearer picture of whether or not someone you know has an alcohol or drug
Can Substance Abuse Be Treated Effectively?
A lot of people are under the assumption that heavy alcohol or
drug users can never fully get better. Others think that they need massive
willpower to even try to overcome their addiction.
The truth is that substance abuse is a mental disorder that can be
treated effectively. Granted, prolonged substance abuse is much more
difficult to treat, but it can still be treated.
If you are struggling with substance abuse, and need help getting
better, you’re not alone. Reading this is an enormous step forward, but be sure
to really ask for help. Talk to your family, because they love you and will
certainly do anything to help you.
Remember that asking for
help doesn’t show weakness. It shows strength. So, don’t hide and think that
the problem will go away. Step up, and decide to make a change, but let others
support you and offer you a helping hand!
A former Director of National Drug Control
Policy, Michael Botticelli is working to end this epidemic and treat people
with addictions with kindness, compassion and fairness. In a personal,
thoughtful talk, he encourages the millions of Americans in recovery today to
make their voices heard and confront the stigma associated with substance use
The 2019 Sanofi Canada health-care survey has reported that more than half of Canadian workers (54%) indicated they have at least one chronic disease or condition. Chronic disease is on the rise is a challenge for both employees and employers.
The most commonly reported issues were mental illness, hypertension, high cholesterol, arthritis and diabetes. Many (42 %) respondents also reported having chronic pain.
More older workers suffered from a chronic disease or condition than those under age 55.
82% of plan sponsors would like their benefit plan to do more to support employees dealing with chronic conditions. 89% of those with chronic pain would like information on ways to manage it.
Almost a third of members with chronic conditions said they take three or more medications regularly, compared to four percent of members without a condition.
Insurers are providing initiatives to help manage chronic diseases.
RBC Insurance offers group benefit members a wellness app, reduced pricing on drug compatibility testing and is piloting a “Manage my Pain” app as well.
Manulife is also pilot testing a pharmacogenetics program.
It is important that plan members are aware of these programs and take advantage of them when possible. This can help members manage their chronic conditions, reduce absenteeism and therefore lost productivity and help manage the cost of drugs.
Sun Life has provided the updated dental fee increases for 2019. Typically, there is an increase across the board for dental
services performed by general practitioners. The information in provincial fee guides
helps to establish reimbursement levels for the dental services plan members
This chart summarizes fee guide increases announced for 2019 by the provincial