Eliminating the “exceptional patient” measure would harm the health of 35,000 Quebecers a year
Montreal, December 5, 2024 – Tens of thousands of Quebecers could lose access to the drugs they need, should the Legault government restrict access to the “exceptional patient” mechanism, warns a new MEI publication launched this morning.
“In the context of budgetary restrictions, important but little-known mechanisms, like the exceptional patient measure, sadly make easy targets for civil servants,” explains Emmanuelle B. Faubert, economist at the MEI and the author of the study. “Already, Bill 15 has greatly restricted access to its in-hospital counterpart, the specific medical necessity measure.”
Created in 2005, the “exceptional patient” mechanism serves as a safety valve for patients who have no other therapeutic options. When patients have exhausted all possible avenues, their doctors can prescribe drugs deemed safe and effective by Health Canada, but not covered by the Régie de l’assurance maladie du Québec (RAMQ).
In 2022, there were 35,836 approved requests to make use of the exceptional patient mechanism, a 58 per cent increase since 2012.
Over the past decade, this mechanism has helped over 340,000 Quebec patients.
In 2023, the adoption of Bill 15 introduced restrictions to the specific medical necessity measure, the in-hospital counterpart of the exceptional patient mechanism. That measure is now available only if delaying the taking of the requested medication would entail a rapid and irreversible deterioration of the patient’s health, in those cases where Quebec disagrees with Health Canada regarding a drug’s therapeutic value.
The publication mentions that numerous groups have voiced concerns that the government could apply a similar treatment to the exceptional patient measure.
The researcher explains that this mechanism notably provides patients with quicker access to innovative drugs.
“Quebec patients suffering from rare diseases often have no other options besides new drugs,” says Ms. Faubert. “The exceptional patient mechanism mitigates the harmful effects of long delays between the approval of a drug by Health Canada and its coverage by the public plan.”
In Canada, once a new drug has been given the green light by Health Canada, it takes another 18 to 21 months on average for a public health insurance plan to decide to cover it. During this time, patients who depend on this coverage do not have access to these treatments.
Already, RAMQ coverage is much less extensive than what private insurers offer, covering 33 per cent fewer individual drugs.
“Respecting healthcare budgets is important, but this must be done by cutting administrative costs, not patient services,” notes Ms. Faubert. “If civil servants recommend that Minister Dubé restrict access to the exceptional patient mechanism, let’s hope he rejects their requests and instead looks into bureaucratic excesses.”
In 2022, the exceptional patient mechanism represented less than one per cent of spending on Health and Social Services.
The MEI study is available here.
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The MEI is an independent public policy think tank with offices in Montreal, Calgary, and Ottawa. Through its publications, media appearances, and advisory services to policymakers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship.
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