EXCEPTIONAL MEDECINES AND EXCEPTIONAL PATIENTS

Hello everyone,

There are procedures to follow in order to obtain acceptance of a request for an exceptional medication or patient. Usually, there are fees related to these requests. 

If the final decision is to change group insurer, there is the grandfather clause (acquired right) which applies. Make sure the request is accepted before changing insurer.

By doing this, the new insurer will make a request to the previous insurer to obtain the list of employees and medications concerned. There may be fees related to this request. On the other hand, this will save these employees additional costs and the need to produce evidence. This will also avoid certain irritants the next time they will purchase these medications at their pharmacy.

Example of an exceptional medication : Ozempic

Example of an exceptional patient :

A person requiring a payment authorization request for a medication not listed in the List of Medications.

Here is the RAMQ website for more information : Exceptional Medicines and Exceptional Patients. By visiting the RAMQ website, you can access the English version by clicking on the three dots in the top right corner and selecting « Translate ».

Have a nice day!

Bard & Associates Inc.

Personal insurance firm

Group Insurance and Group Annuity Plans