On November 26, the Minister of Finance Carlos Leitão tabled an omnibus bill the measures of which, once implemented, will return Québec to a balanced budget. One of the measures explicitly allows the Minister of Health and Social Services to make a listing agreement with drug manufacturers, a significant shift in Québec's reimbursement policy.
More specifically, under Bill 28, the Minister of Health and Social Services will be allowed, before a medication is entered on the list of medications whose cost is covered by the basic prescription drug insurance plan, to make a listing agreement with its manufacturer.
Bill 28 is evidence that Québec has officially decided to follow the approach favoured by other Canadian provinces that have been making such agreements with drug manufacturers since 2006. One of the claimed benefits of listing and "risk-sharing" agreements is that they give provinces better access to certain drugs, even leading to economies of scale when volume discounts or rebates are involved. According to the Québec government, this measure should generate an estimated $25 million in savings for the province.
This measure could also promote the consideration of parameters other than price alone when entering drugs on the list of medications insured in Québec. Indeed, the Minister and manufacturers should have greater flexibility to enter into terms and conditions on a case-by-case basis, thus ensuring the optimal use of drugs as well as fair and equitable access.
While Bill 28 bears some similarities to other Canadian models, it also has important differences. For example, the bill provides that the price of the medication indicated on the list will not take into consideration the sums paid pursuant to a listing agreement. Moreover, the anticipated amendments indicate that despite the Act respecting Access to documents held by public bodies and the Protection of personal information, no person will have a right of access to a listing agreement. As in Ontario, information published after an agreement is entered into will typically include the name of the manufacturer and that of the drug. However, Bill 28 suggests publishing the annual total sum received pursuant to listing agreements, but only to the extent that at least three agreements made with different drug manufacturers are in force in the fiscal year.
What is more, a financial return that is permitted under a listing agreement contemplating a regular list of medications is usually paid to the prescription drug insurance fund, while a return paid under a listing agreement contemplating the list of medications offered in an institution would instead be paid into a fund managed by the Minister of Health and Social Services. Bill 28 currently does not provide for any particular procedure in cases where a comprehensive agreement contemplates entering a medication on both Québec lists.
Bill 28 is a turning point for drug reimbursements in Québec. It should incite Canadian pharmaceutical companies to review their reimbursement approach and strategy in Québec. Some companies may even see this as an opportunity to optimize their drug reimbursement profiles.
Bill 28 also raises a certain number of questions, such as the impact this new measure will have on the private sector and how it will be harmonized with section 52.1 of the Act respecting prescription drug insurance, which authorizes the Minister to make financial risk-sharing agreements with manufacturers.
Bill 28 was tabled by the Minister of Finance, Mr. Carlos Leitão, at the November 26 session. Any amendments to the bill should be made in the next phases of its development.
Note: Mélanie Bourassa Forcier is co-author of this bulletin.
 Bill 28, An Act mainly to implement certain provisions of the Budget Speech of 4 June 2014 and return to a balanced budget in 2015-2016, first session, 41st legislature, Québec, 2014, sections 173 and 179.