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Dispensing fees : the AQPP door a judgement call


Denis Méthot

6 March 2018 13:30

Photo : Freepik

TheAssociation québécoise des pharmaciens propriétaires (AQPP) is appealing a judgment issued two weeks ago by the Quebec superior Court, which would allow private insurers to have access to the professional fees of pharmacists.

The Court had then rejected the interpretation of the law and the arguments advanced by the AQPP. The latter seeks to restrict the issuance of these invoices only to customers in person. Pharmacists are required to submit a detailed invoice including their fees to their clients since the fall of 2017. The private insurers also want to obtain this information from the Régie de l’assurance maladie du Québec (RAMQ).

The association has addressed to the superior Court to prevent the Régie to transmit the detail of these fees to the insurance industry of people. The parties were heard on 28 and 29 November. The private insurers were not involved in the legal debate.

Obligation only to the physical persons

The AQPP was asking the Court to interpret a new provision added to the Act respecting prescription drug insurance. The dispute between the parties focused on section 8.1.1 of this law. Based on the terms of this article, which says that» a pharmacist shall submit a detailed invoice to the person who is claimed the payment of a pharmaceutical service, drug or supply covered by the general regime «. The association argued then that the pharmacist has no duty to one person, is the one who presents at the pharmacy.

According to its interpretation, its members do not have to communicate such invoice to a person other than the person who obtains the property. According to the AQPP, their obligation in connection with the delivery of the bill is limited to persons purchasing the pharmaceutical services, to the exclusion of the insurers who are called upon to contribute financially.

Insurers must also receive a copy of the invoice

The board and the Attorney general of Québec have seen things reverse. According to them, in the framework of the private plan, the insurers called upon to pay, too, must receive a copy of the invoice. To their point of view, the pharmacist must also forward a copy of the invoice to the insurer of his client, or to the administrator of an employee benefit plan, when the latter assumes the payment, in whole or in part.

The Court therefore had to decide the meaning of the statutory provision challenged as to (x) the recipient (s) of the invoice.

Extended interpretation «of a person»

In a judgment rendered February 26, last, the judge Daniel Dumais has given reason to the Régie and rejected the arguments of the AQPP, based on an extended interpretation of the expression » a person «.

«The Court, he wrote in his judgment, does not subscribe to this reading of the provision. On the one hand, the use of the singular does not exclude that the obligation applies to several people. Section 54 of the interpretation Act québec specifically provides : “The number of singular extends to several persons or to several things of the same species, whenever the context lends itself to this extension”. «

No requirement of physical presence

«In the instant case, adds the magistrate, the circumstances lend themselves to the inclusion set out in the interpretation Act, rather than to restrict the meaning of the word «person» to an individual. If it was only a natural person, it would be rather referred to the “qualifying person”, as is done in several places in the act. On the other hand, the word “submit” does not necessarily, in the eyes of the undersigned, the physical presence of the recipient. As for a payment or a notice of non-renewal, this could be done electronically. “Surrender” has rather the meaning of “transmit”. «

«In the final article 8.1.1 does not seem to limit, on its face, the rebate obligation to a single person, which requires the presence at the pharmacy. This duty can extend to more than one, including a legal person. We would have been able to write a more explicit, referring specifically to insurers, but this is not required. The formulation chosen will lead to the same outcome, » he also wrote.

Promote competition

The court added further that the disclosure of the fees on the bill promotes competition and can help to alleviate the burden of the payers. This objective militates in favor of the interpretation of the defendants, rather than restrictive, of the plaintiff. He also rejected another argument of the AQPP to the effect that, send a copy of the invoices to insurers would result in the imposition of an administrative burden, and financial pharmacists.

«It is common for a new law to entail financial consequences to the people to whom it is addressed, especially in terms of public interest, says the judge Dumais. In addition, the pharmacist is not obliged to send the invoice to the insurer requires payment in full of the insured person. The decision is up to them. «

In short, said the judge, the transparency sought was more likely to be achieved if one expands the recipients of the invoices rather than restrict it. The delivery of invoices to insurers and payers is certainly more compatible with the purpose of the law, and can only be advantageous for the citizens «.

The CLHIA welcomes the decision

The president of the Québec division of thecanadian Association of insurance companies of persons (CLHIA Quebec), Lyne Duhaime, was delighted with this decision.

«We are pleased with the decision of the superior Court, which confirms the government’s intention to provide tools for the private payers, employers, and workers, to control the costs of drugs,» said Ms. Duhaime by e-mail, in a meeting of the board of directors in Toronto.

The minister of Health, Gaétan Barrette, has also welcomed the judgement. «I am pleased with this decision «, he declared to the daily Press.

Call of the AQPP

The AQPP has informed on march 2 that it would the decision of the judge Daniel Dumais appeal in a statement of four lines.

«Following the rejection of its request for a declaratory judgment, written-on, the AQPP shows obviously disappointed by this decision and disagree with its conclusions. The mandate is to bring this appeal judgment has already been given to the prosecutors of the AQPP. The AQPP will not issue any further comment and will not grant any interview. «

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