Reimbursement for biologics in Quebec
Exceptional medications, biosimilars and support programs: what determines the amount you pay for a Crohn's disease treatment.
Why reimbursement is more complicated here
The biologic therapies used in Crohn's disease and ulcerative colitis are among the most expensive medications on the plan. They are therefore not reimbursed automatically: every patient goes through an authorization request, and Quebec's public plan applies an additional rule about biosimilars. Understanding these two mechanisms prevents a lot of unpleasant surprises.
Exceptional medications, in plain terms
An exceptional medication is covered by the public plan only if the patient meets recognized indications. Your gastroenterologist submits a payment authorization request to RAMQ; reimbursement begins once the authorization is granted, and it must be renewed periodically. If your situation does not match the listed indications, another route exists, called the exceptional patient measure. The pharmacy can track the file and warn you before the authorization expires — that expiry is often where treatment interruptions begin.
The biosimilar rule
Since April 2022, where a biosimilar exists for a given biologic, the biosimilar is what the public plan reimburses. The measure is intended to reduce treatment costs across the plan. Exceptions are provided for and assessed case by case.
Pregnancy.
People under 18, with a switch expected within twelve months of their eighteenth birthday.
Certain specific clinical situations, notably after several documented treatment failures for the same condition.
If a switch applies to you, your gastroenterologist oversees it. One practical detail often gets overlooked: the biosimilar injection device is not always identical to the one you knew. Come by the pharmacy and we will go through it with you.
Private insurance or the public plan?
In Quebec, if you have access to a group insurance plan you are required to join it; the public plan covers those who do not. Both require prior authorization for biologics, but their forms, timelines and biosimilar rules differ. Job changes, retirement and the move onto the public plan are the moments most likely to interrupt treatment: tell your pharmacy before the change takes effect, not after.
Manufacturer support programs
Every biologic therapy comes with a support program run by its manufacturer. Depending on the program these offer help with reimbursement paperwork, a dedicated coordinator, injection training, and sometimes a nurse visit at home for the first doses. They are free to the patient and widely underused simply because people do not know they exist. We enrol you in the one that matches your treatment and deal with them on your behalf when needed.
Frequently asked questions
Paperwork to sort out for your treatment?
Call us: we prepare the requests with your clinic and keep track of the deadlines.
(450) 689-8181Content reviewed by a pharmacist at the pharmacy · Updated July 2026
This page is for information only and does not replace advice from your physician or pharmacist. It is not intended to promote any particular medication. Always speak to your care team before changing a treatment.