Exceptional Medications

The List of Medications contains some exceptional medications for which coverage is provided under the basic plan only in the cases, on the conditions or for the therapeutic indications determined in the regulation of the Minister. These conditions may vary depending on whether coverage is provided by the Régie de l'assurance maladie du Québec (RAMQ) or under a group insurance or an employee benefit plan.

The exceptional medications measure strives to fulfill the following goals:

1. For the public plan to cover only the cost of exceptional medications if they are used for therapeutic indications recognized by INESSS.
2. For the cost of drug products on the “exceptional medications” list to be covered, in the following exceptional circumstances:

• When a drug product is considered effective for limited indications, since its effectiveness or the cost of treatment cannot justify its regular and continued use for other indications;
• When a drug product does not provide a therapeutic advantage that would justify its higher cost compared to other products on the list that possess the same pharmacotherapeutic properties, but when those drugs are not tolerated, are contra-indicated or have been rendered ineffective for a patient’s clinical condition.

See appendix IV of the List of Medications and indications recognized for payment.