Adjustment Made to the Out-of-Pocket Maximum in Quebec
On July 1, 2026, the Régie de l’assurance maladie du Québec (RAMQ) increased the annual out-of-pocket maximum under the Quebec drug insurance plan. This change affects plan sponsors who provide drug coverage to plan members residing in Quebec.
What Changed:
RAMQ adjusts the rates for Quebec’s Public Prescription Drug Insurance Plan every year on July 1. For the period of July 1, 2026 to June 30, 2027:
- Out-of-pocket maximum: increased to $1,263 per year ($105.25 per month), up from $1,232. This is the most a plan member pays annually for drugs listed on the RAMQ formulary.
- Co-insurance: no change. Plans must continue to cover a minimum of 70% of eligible drug costs.
- Exception: persons age 65 or over who receive less than 94% of the maximum Guaranteed Income Supplement have a lower maximum of $697 per year ($58.08 per month).
What This Means for Plan Sponsors:
Private plans covering Quebec residents must meet or exceed RAMQ minimums, so drug claims for Quebec plan members are now subject to the new $1,263 maximum. Insurers have updated their systems to reflect the change. No immediate rate adjustments are expected, and the impact on plan members and claims experience should be minimal. No action is required from plan sponsors.
Sources:
- Régie de l’assurance maladie du Québec, Rates in Effect
- Sunlife (July 9, 2026), Change to the out-of-pocket maximum in Quebec