TORONTO, June 10, 2026 /CNW/ - Eli Lilly Canada Inc. (Lilly) is pleased to announce that Verzenio® (abemaciclib) is now publicly reimbursed in Québec for eligible patients living with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced or metastatic breast cancer (mBC). Following the successful completion of a pan-Canadian Pharmaceutical Alliance (pCPA) negotiations in April 2026, Régie de l'assurance maladie du Québec (RAMQ) has as of May 28, 2026, added two mBC indications for Verzenio® to the list of medications, in addition to the EBC indication. As of May 28, 2026, prescribers can submit Médicament d'exception requests to RAMQ for Verzenio® in combination with a non-steroidal aromatase inhibitor (NSAI), as an initial endocrine therapy or in combination with fulvestrant, for the treatment of HR+, HER2- locally advanced, unresectable metastatic breast cancer (for newly diagnosed cancer, or cancer that has progressed during or following endocrine therapy). This milestone is a significant achievement for providing better access to Verzenio® in Québec, bringing Canadians impacted by advanced breast cancer one step closer to timely access to innovative treatment options.
Lilly is committed to working collaboratively with stakeholders across the healthcare system to help improve timely access for eligible patients living with metastatic breast cancer.
"Breast cancer remains one of the most commonly diagnosed cancers among women in Canada, and metastatic breast cancer continues to have a profound impact on patients, families and caregivers," said Dr. Jamil Asselah, Medical Oncologist at McGill University Health Centre (MUHC) and Associate Professor at McGill University. "Reimbursement for these metastatic breast cancer indications marks meaningful progress in improving access to Verzenio for eligible patients in Québec, and reflects the importance of continued innovation in breast cancer care."
Approximately 75 per cent of breast cancers are hormone receptor-positive (HR+) and 66 per cent to 75 per cent are HER2-negative. While early-stage breast cancer is treated with therapies of curative intent, metastatic breast cancer remains incurable, with a five-year survival rate of approximately 23 per cent.1
In Canada, an estimated 5,400 women are expected to die from breast cancer in 2026, representing approximately 13 per cent of all cancer deaths among women. On average, 15 women in Canada die from breast cancer every day.2
"More treatment options mean more choice for people living with metastatic breast cancer, and that matters. No two patient experiences are the same, including how people respond to treatment and the side effects they are willing or able to tolerate," said MJ DeCoteau, Founder & Executive Director, Rethink Breast Cancer. "Access to therapies like Verzenio helps support more personalized treatment decisions, giving patients and their healthcare teams greater flexibility to choose the option that best fits their lives, priorities, and goals. Today's announcement is welcome news for eligible patients in Quebec living with metastatic breast cancer."
Verzenio® is a cyclin-dependent kinase (CDK) 4 and 6 inhibitor currently approved in Canada for certain patients with HR+, HER2- advanced or metastatic breast cancer.3
Lilly remains committed to working collaboratively with healthcare systems, clinicians, patient advocacy organizations and governments to help improve quality of life and access to care for Canadians affected by metastatic breast cancer.
About Verzenio® (abemaciclib)
Verzenio® abemaciclib is a targeted treatment known as a CDK4/6 inhibitor. Verzenio® is a non-chemotherapy oral tablet.
Verzenio® works inside the cell to block CDK4/6 activity and help stop the growth of cancer cells, so they may eventually die (based on preclinical studies). Cyclin-dependent kinases (CDK)4/6 are activated by binding to D-cyclins. In estrogen receptor-positive (ER+) breast cancer cell lines, cyclin D1 and CDK4/6 promote phosphorylation of the retinoblastoma protein (Rb), cell cycle progression, and cell proliferation.
In vitro, continuous exposure to Verzenio® inhibited Rb phosphorylation and blocked progression from G1 to S phase of the cell cycle, resulting in senescence and apoptosis (cell death). Preclinically, Verzenio® dosed daily without interruption resulted in reduction of tumour size. Inhibiting CDK4/6 in healthy cells can result in side effects, some of which may be serious. Clinical evidence also suggests that Verzenio® crosses the blood-brain barrier. In patients with advanced cancer, including breast cancer, concentrations of Verzenio® and its active metabolites (M2 and M20) in cerebrospinal fluid are comparable to unbound plasma concentrations.
Verzenio® is Lilly's first solid oral dosage form to be made using a faster, more efficient process known as continuous manufacturing. Continuous manufacturing is a new and advanced type of manufacturing within the pharmaceutical industry, and Lilly is one of the first companies to use this technology.
About Lilly Canada
Lilly is a medicine company turning science into healing to make life better for people around the world. Lilly has been pioneering life-changing discoveries for nearly 150 years, and today our medicines help more than 51 million people across the globe. Lilly's Canadian Affiliate, Eli Lilly Canada Inc. was established in 1938, the result of a research collaboration with scientists at the University of Toronto which eventually produced the world's first commercially available insulin.
Harnessing the power of biotechnology, chemistry and genetic medicine, our scientists are urgently advancing new discoveries to solve some of the world's most significant health challenges: redefining diabetes care; treating obesity and curtailing its most devastating long-term effects; advancing the fight against Alzheimer's disease; providing solutions to some of the most debilitating immune system disorders; and transforming the most difficult-to-treat cancers into manageable diseases. With each step toward a healthier world, we're motivated by one thing: making life better for millions more people. That includes delivering innovative clinical trials that reflect the diversity of our world and working to ensure our medicines are accessible and affordable.
To learn more about Lilly Canada, visit www.lilly.com/en-CA, or follow Lilly Canada on LinkedIn.
For more information, please contact: Ethan Pigott Director of Communications & External Affairs Eli Lilly Canada Inc. 1+ 416-770-5843 pigott_ethan@lilly.com
Legal deposit — Bibliothèque et Archives nationales du Québec, 2026
Legal deposit — Bibliothèque et Archives nationales du Québec, 2026 ISSN 1913-2794 ISBN 978-2-555-03871-4 (PDF) Québec, 26 May 2026
ISSN 1913-2794 ISBN 978-2-555-03871-4 (PDF)
Québec, 26 May 2026
Legal deposit — Bibliothèque et Archives nationales du Québec, 2026 ISSN 1913-2794 ISBN 978-2-555-03871-4 (PDF) Québec, 26 May 2026
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Schedule 1
List of Medications 28 May 2026
Table of Contents
1. ESTABLISHING THE PRICE OF A DRUG..............................................................................................3 2. BIOLOGIC DRUGS .................................................................................................................................7 3. EXTEMPORANEOUS PREPARATIONS................................................................................................8 4. EXCEPTIONAL MEDICATIONS..............................................................................................................9 5. SUPPLIES.............................................................................................................................................12 6. MEDICATIONS COVERED UNDER THE EXCEPTION PATIENT MEASURE.....................................12 7. EXCEPTIONS TO THE TEMPORARY EXCLUSION OF A MEDICATION FROM COVERAGE UNDER THE BASIC PRESCRIPTION DRUG INSURANCE PLAN......................................................19 8. PROTON PUMP INHIBITORS (PPI).....................................................................................................20 9. MAXIMUM NUMBER OF BLOOD GLUCOSE TEST STRIPS (REACTIVE QUANTITATIVE)...............21 10. TREATMENT OF CORONAVIRUS DISEASE (COVID-19)...................................................................22
APPENDIX I: Manufacturers That Have Submitted Different Guaranteed Selling Prices for Wholesalers and Pharmacists APPENDIX II: Drug Wholesalers Accredited by the Minister and Each Wholesaler’s Mark-Up APPENDIX III: Products for Which the Wholesaler’s Mark-Up Is Limited to a Maximum Amount APPENDIX III.1: List of Standardized Extemporaneous Preparations APPENDIX IV: List of Exceptional Medications With Recognized Indications for Payment APPENDIX IV.1: List of Exceptional Medications With Recognized Indications for Payment That Remain Covered for Persons Undergoing Treatment APPENDIX IV.2: Exceptional Medications Whose Insurance Coverage is Maintained for Persons Undergoing a Treatment According to the Conditions set out in section 4.2.3. of the List of Medications APPENDIX V: List of Drugs for Which the Lowest Price Method Does Not Apply
The prices indicated on the List of Medications (List) are established according to the "guaranteed selling price” concept, in keeping with the manufacturer’s commitment and in accordance with the methods of establishing drug prices provided for in section 60 of the Act respecting prescription drug insurance (chapter A-29.01).
However, for certain drugs no price is indicated on the List, in which case the payable price is the pharmacist’s cost price. Such drugs may include:
− drugs produced by non-accredited manufacturers but considered unique and essential (identified by the symbol “UE” in the “unit price” column);
− products for extemporaneous preparations;
− solvents, vehicles and adjuvants;
− supplies;
− drugs listed by generic name only, with no brand name or manufacturer’s name indicated.
The payable price is also the pharmacist’s cost price for a drug that does not appear on the List which is exceptionally covered by the basic prescription drug insurance plan in application of the exception patient measure set out in item 6.
For drugs that have been withdrawn from the market by the manufacturer, the symbol “W” appears in the “unit price” column. These drugs remain payable during the period of validity of this edition, so that existing stocks can be sold.
1.1. Guaranteed selling price
The manufacturer’s commitment stipulates that the manufacturer must submit a guaranteed selling price, per package size, for any drug it wishes to have included on the List. The number of package sizes is limited to two, and the price submitted must reflect prices for quantities that are multiples of these package sizes.
Where the therapeutic use of more than two package sizes has been established, as in the case of certain drugs such as antibiotics in oral suspensions, ophthalmic solutions, and topical creams and ointments, the manufacturer may submit a guaranteed selling price for each package size.
The guaranteed selling price must remain in effect during the period for which the List is valid.
The guaranteed selling price may differ for sales to pharmacists and sales to wholesalers, in which case the difference between the pharmacist’s price and the wholesaler’s price must not exceed 6.50% for any package size but may be different for each product in question. For a given product, the difference must be the same for all package sizes. A manufacturer’s guaranteed selling price for sales to wholesalers must be the same for all wholesalers.
It should be noted that the guaranteed selling price indicated on the list is the guaranteed selling price for sales to pharmacists.
Manufacturers that have submitted different guaranteed selling prices for sales to pharmacists and sales to wholesalers are listed in Appendix I.
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1.2. Price Payable
The price of a drug is the price at which it is sold by an accredited manufacturer or wholesaler. This price is established according to the method described below or, in certain cases, is the maximum price indicated on the List.
1.2.1. Actual purchase price
The method used to establish the payable price is the actual purchase price method.
Under this method, the price paid to a pharmacist is the price indicated on the edition of the List that is valid at the time the prescription is filled, taking into account the source of supply and the package size.
Under this method, where no price is indicated on the List for a drug or a product, or where a drug that does not appear on the List is exceptionally covered by the basic prescription drug insurance plan in application of the exception patient measure set out in item 6, the payable price is the pharmacist’s cost price.
1.2.2. Lowest price
The lowest price applies when two or more manufacturers have drugs appearing on the List that have the same generic name, dosage form and strength.
The lowest price also applies where an exceptional medication, prescribed for a therapeutic indication not set out in this list with regard to this medication, is exceptionally insured under the basic prescription drug insurance plan pursuant to item 6.
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1.2.2.1. Lowest price method
The lowest price method consists of establishing the payable price for drugs with the same generic name, dosage form and strength based on the brand name whose selling price guaranteed by the manufacturer is the lowest for a given package size.
However, for solid oral drugs with the same generic name, dosage form and strength, the lowest price method consists of establishing the payable price for drugs based on the unit price of the brand name whose selling price guaranteed by the manufacturer is the lowest, regardless of its package size.
1.2.2.2. Grouping of dosage forms and strengths
For the purpose of applying the lowest price method, certain dosage forms or active drug ingredient strengths may be grouped together under the same generic name. In such case, determination of the payable price is based on the corresponding doses.
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1.2.2.3. Exceptions to the lowest payable price
The lowest price method does not apply where the prescriber indicates not to replace a brand name drug that he has prescribed with a generic name drug in the following cases and conditions:
(1) for reimbursement of PrevacidTM FasTab, when prescribed to a person under the age of 18 for whom the use of an orally disintegrating tablet is essential to obtain the expected clinical results;
(2) for reimbursement of DDAVPTM Melt, when prescribed to a person for whom the use of an orally disintegrating tablet is essential to obtain the expected clinical results;
(3) for reimbursement of CellceptTM, ClozarilTM, DepakeneTM, DilantinTM, Dilantin-125TM, EpivalTM, ImuranTM, MyforticTM, OxyNeoTM, PrografTM, TegretolTM or Tegretol CRTM when prescribed to a person who has already received a reimbursement in the 12 months preceding 2 July 2025 following the presentation of a prescription on which the prescriber indicated not to replace this drug;
(3.1) for reimbursement of AdvagrafTM, when prescribed to a person who has already received a reimbursement in the 12 months preceding 4 February 2026.
(4) for reimbursement of another drug on the List, when the following conditions are met:
(a) the least expensive drug with the same generic name causes a documented allergy or intolerance to a non-medicinal ingredient present in its composition but absent from that of the brand name drug;
(b) in the case of intolerance, it is serious and has resulted in hospitalization or prolongation of hospitalization, emergency medical intervention or persistent or significant disability or incapacity;
(c) a generic drug with a composition identical to that of the brand name drug is not available in Canada;
(d) a generic drug that does not contain the non-medicinal ingredient causing the allergy or severe intolerance is not available in Canada.
Any person seeking the exception set out in subparagraph 4 of the first paragraph must, through the prescriber, complete the form provided for this purpose by the Régie de l’assurance maladie du Québec (Régie) and sent it back. When the request is accepted, the drug covered is excluded from the lowest price method only for the period authorized by the Régie.
The lowest price method also does not apply to the drugs appearing in Appendix V. The drugs in this appendix have one of the following characteristics:
− they are highly toxic or have a narrow therapeutic index;
− their onset of action and absorption rate are clinically important;
− they have a particular pharmaceutical form or a particular use.
Likewise, the lowest price method does not apply to biologic drugs referred to in section 2.1..
Likewise, the lowest price method does not apply to drugs that are insured under the basic plan under sections 4.2.2. and 4.2.3..
1.2.3. Maximum amount
The Minister may establish a maximum payable amount for a drug, in which case the payable price may not exceed the maximum amount indicated on the List.
However, provided that the conditions referred to in 8 are fulfilled, the maximum amount indicated on the List TM for the payment of Nexium and PrevacidTM FasTab does not apply when a patient suffers from severe dysphagia or is fitted with a nasogastric or gastrojejunal tube and is able to take the medication only if dissolved. In such cases, the payable price is the actual purchase price paid for the medication by the pharmacist.
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1.2.4. Accredited drug wholesaler’s mark-up
The drug wholesaler’s mark-up is payable only if the drug was actually purchased through an accredited wholesaler. For certain expensive drugs, the mark-up may be limited to a maximum amount, under the terms and conditions described below.
Under this provision, the wholesaler must, in keeping with its commitment, declare the percentage mark-up that it must add exclusively to the manufacturer’s guaranteed selling price for drugs appearing on the List during the period for which it is valid, except drugs for which different guaranteed selling prices for sales to wholesalers and sales to pharmacists are submitted.
The List of drug wholesalers accredited by the Minister and their mark-ups for the period of validity of the List are set out in Appendix II.
1.2.4.1. Maximum mark-up
Under the regulatory provisions, the mark-up on certain expensive drugs may be limited to a maximum amount.
For these drugs, the wholesaler’s mark-up is limited to a maximum of $49. The products to which this measure applies are those whose guaranteed selling price for sales to wholesalers, for the smallest package size or its indivisible multiple, is $754 or more. The price appearing on the List is the guaranteed selling price for sales to pharmacists and does not include the wholesaler’s mark-up.
Products for which the wholesaler’s mark-up is limited to $49 are listed in Appendix III. This mark-up is limited to the same amount for the drugs mentioned in appendices IV.1 and IV.2.
1.2.4.2. Two guaranteed selling prices
Where a manufacturer has submitted different guaranteed selling prices for sales to wholesalers and sales to pharmacists, the payable price is established as follows:
If the difference between the guaranteed selling prices for sales to wholesalers and sales to pharmacists is equal to or greater than 5%, this difference constitutes the wholesaler’s mark-up. The payable price is then the guaranteed selling price for sales to pharmacists, except in the case of expensive products, for which the mark-up is limited to $49. If the difference between the guaranteed selling prices for sales to wholesalers and sales to pharmacists is less than 5%, the payable price is the guaranteed selling price for sales to wholesalers, increased by the wholesaler’s mark-up.
1.2.5. Conditions of supply
Products on the List are payable by the Régie to the pharmacist only if the pharmacist has purchased them through an accredited manufacturer or an accredited wholesaler.
When obtaining drug supplies, pharmacists must apply sound management practices and make rational purchases based on the quantity of a drug dispensed over a period of at least 30 days.
1.2.6. Payable price for drugs supplied by institutions
Under section 37 of the Pharmacy Act (chapter P-10), institutions are authorized to supply drugs to persons other than persons admitted or registered with them. In addition to the responsibilities entrusted to them under the Regulation respecting the application of the Hospital Insurance Act (chapter A-28, r. 1), these institutions may bill the basic prescription drug insurance plan for drugs appearing on the List, where these drugs are supplied to persons insured under the basic plan.
In such cases, the price payable to institutions is the lesser of the actual purchase price and the price established according to the method described in the List.
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2. BIOLOGIC DRUGS
2.1. Definitions
A biologic drug is a drug produced from living cells, such as animal cells, bacteria or yeast. A biosimilar is a very similar copy of a biologic drug. Where a biosimilar is marketed, the original biological drug to which it is compared is called the reference biologic drug.
2.2. General rules
When a biosimilar drug is added to the List on two consecutive updates, coverage of its reference biologic drug under the basic prescription drug insurance plan ends, effective as of the next update. As of this latest update, only the biosimilar drug to this reference biological drug is covered by the basic prescription drug insurance plan, except in the cases set out in item 2.3.
An original biologic drug not entered on the List and whose payment is allowed in application of the exception patient measure set out in item 6 of the List is covered by the basic prescription drug insurance plan until a biosimilar of this drug is marketed in Canada.
The reference biologic drug is then no longer covered by the basic prescription drug insurance plan, except in the cases set out in item 2.3.
2.3. Maintaining coverage under the basic prescription drug insurance plan
Notwithstanding the first or second paragraph of item 2.2., the cost of a reference biologic drug continues to be covered by the basic prescription drug insurance plan for an eligible person undergoing treatment with this reference biologic drug and who has received a reimbursement from the Régie, an insurer or an administrator of an employee benefit plan before the end of coverage of the prescription drug under item 2.2. in the following cases:
(1) (subparagraph repealed);
(2) for a pregnant woman, including the (12) months following delivery;
(3) for a person under the age of 18 for the remaining duration of their authorization, for a maximum of (12) months following the date of their 18th birthday or, in the absence of authorization, until the date of their 19th birthday;
(4) for a person having experienced a therapeutic failure before the beginning of the treatment with the reference biologic drug and with at least two other biologic drugs:
(a) of generic names different from that of the reference biologic drug and between them;
(b) used to treat the same medical condition.
Notwithstanding the first paragraph of item 2.2., the cost of HumalogTM continues to be covered by the basic prescription drug insurance plan if the eligible person undergoing treatment with this drug by insulin pump and if the person has begun a treatment and received a reimbursement before 3 March 2021.
Notwithstanding the first paragraph of item 2.2., the cost of LucentisTM continues to be covered by the basic prescription drug insurance plan if the eligible person undergoing treatment with this drug is monocular and if the person has begun a treatment and received a reimbursement before 13 December 2023.
Notwithstanding the first paragraph of item 2.2., the cost of NovoRapidTM S.C. Inj. Sol. 100 U/mL (10 mL) continues to be covered by the basic prescription drug insurance plan if the eligible person undergoing treatment with this drug by insulin pump and if the person has begun a treatment and received a reimbursement before 4 July 2024.
Notwithstanding the first paragraph of item 2.2., the cost of EyleaTM continues to be covered by the basic prescription drug insurance plan if the eligible person undergoing treatment with this drug is monocular and if the person has begun a treatment and received a reimbursement before 6 November 2025.
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2.4. Transition toward another biologic drug
Where a reference biologic drug is covered by the basic prescription drug insurance plan only in the cases set out in item 2.3., the eligible person who has obtained a reimbursement for this drug may not obtain a reimbursement for another original biologic drug unless the prescriber confirms that there was a therapeutic failure with the reference biologic drug.
Notwithstanding the first paragraph, the eligible person who has obtained a reimbursement for EyleaTM may obtain a reimbursement for EyleaTM HD.
3. EXTEMPORANEOUS PREPARATIONS
3.1. Definition
An extemporaneous preparation is any drug prepared by a pharmacist from a prescription, as opposed to an officinal preparation, which is pre-prepared.
3.2. Extemporaneous preparations whose cost is covered by the basic prescription drug insurance plan
The cost of an extemporaneous preparation is covered by the basic plan if the preparation is an extemporaneous mixture of products appearing on the List, is not equivalent to a drug already manufactured, and consists of:
− a systemic-effect preparation manufactured from oral forms of drugs already appearing on the List and consisting of at least one active ingredient.
− a mouthwash preparation resulting from the mixture:
• of two or more of the following drugs in non-injectable form: diphenhydramine hydro-chloride, erythromycin, hydroxyzine, ketoconazole, lidocaine, magnesium hydroxide / aluminum hydroxide, nystatin, sucralfate, tetracycline and a corticosteroid, in association, where applicable, with one or more vehicles, solvents or adjuvants or
• of an oral form of tranexamic acid with one or more vehicles, solvents or adjuvants.
− a preparation for topical use composed of a mixture of a drug listed in Class 84:00 Skin and Mucous Membrane Agents of the List and of one or more of the following products for extemporaneous preparations: salicylic acid, sulfur and tar in association, where applicable, with one or more vehicles, solvents or adjuvants.
− a preparation for topical use composed of one or more of the following products: salicylic acid, erythromycin, sulfur, tar and hydrocortisone in a cream, ethanol, ointment, oil or lotion base, but not a preparation that is only hydrocortisone-based that has a concentration of less than 1%.
• tobramycin in concentrations of more than 3 mg/mL
or
• cyclosporine at a concentration of 1% or 2%
or
• cysteamine.
− a solution or oral suspension of folic acid, cyclephosphamide (from intravenous injection powder), dexamethasone, gabapentin, hydroxyurea, methadone, metronidazole, phytonadione, prednisone, pyridoxine (from injection solution 100 mg/ml) or vancomycin.
− an oral suspension of sulfamethoxazole and trimethoprim.one of the following preparations:
• a sucralfate-based preparation for rectal use;
• a topical preparation containing glyceryl trinitrate, nifedipine or diltiazem.
− a preparation for oral use of sodium benzoate.
− a preparation for oral use of clomiphene citrate.
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When an extemporaneous preparation listed in Appendix III.1 entitled List of Standardized Extemporaneous Preparations is suitable for the eligible person, it must be prepared in accordance with the standardized master formula published on the CHU Sainte-Justine website. For the purposes of this paragraph, such an extemporaneous preparation is not suitable for the specific needs of an eligible person, particularly in the case of an allergy or intolerance.
In addition to the products listed in the Regular Section and the Exceptional Medications section of the List, products for extemporaneous preparations are grouped in the specific section of the List that applies to them. Vehicles, solvents, or adjuvants whose price is payable by the Régie are those listed in the specific section that applies to them.
3.3. Payable price
The method applicable for establishing the payable price for products for extemporaneous preparations is the price indicated on the List. Where no price is indicated, the payable price is the pharmacist’s cost price.
4. EXCEPTIONAL MEDICATIONS
4.1. Classification of exceptional medications in the List
4.1. Classification of exceptional medications in the List
The exceptional medications are grouped together in appendices IV, IV.1 and IV.2 to the List.
Regarding the exceptional medications listed in Appendix IV, the exceptional medications measure is intended to:
(a) ensure that the cost of drugs classified as exceptional medications be covered by the basic plan only when used for the therapeutic indications recognized by the Institut national d’excellence en santé et en services sociaux, hereinafter “INESSS”.
(b) permit, on an exceptional basis, the payment of the cost of drugs where they:
− are considered effective for limited indications, since neither their effectiveness nor the cost of treatment warrants their regular and continuous use for other indications;
− offer no therapeutic advantages to warrant a higher cost than the cost of using products that have the same pharmacotherapeutic properties and that appear on the List, but where the latter are not tolerated, are contraindicated, or have been rendered ineffective by the patient’s clinical condition.
Regarding the exceptional medications listed in Appendix IV.1, the exceptional medications measure is intended, under the basic plan, and only according to the conditions set out in sections 4.2.1. and 4.2.2. hereof, to guarantee the cost of drugs.
Regarding the exceptional medications listed in Appendix IV.2, the exceptional medications measure is intended, under the basic plan and only according to the conditions set out in section 4.2.3. hereof, to guarantee the cost of drugs without a particular therapeutic indication.
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4.2. Conditions of coverage under the basic prescription drug insurance plan
4.2.1. Medications listed in appendices IV and IV.1
The exceptional medications listed in appendices IV and IV.1 are insured under the basic plan where the following conditions are fulfilled:
(1) in the case of persons whose coverage under the basic plan is provided by the Régie, a prior request for authorization, duly completed in accordance with the form provided for this purpose by the latter in accordance with the Regulation respecting the terms and conditions for the issuance of health insurance cards and the transmittal of statements of fees and claims (chapter A-29, r. 7.2) was sent to the Régie;
(2) in the case of persons whose basic plan coverage is provided by insurers transacting group insurance or by administrators of private-sector employee benefit plans, a prior request for authorization, if required under the applicable group insurance contract or employee benefit plan, was sent to the insurer or to the administrator of the employee benefit plan, according to the terms and conditions provided for in that contract or plan.
For their prior request for authorization to be processed, the eligible person must send, either personally or through their prescriber, all the documents required by the Régie, including, in particular, reports and test results.
However, these drugs are covered only for the period authorized, if applicable, by the Régie, the insurer or the administrator of the employee benefit plan in question, if they are prescribed for the therapeutic indications provided for each of them.
4.2.2. Medications listed in Appendix IV.1
The following exceptional medications indicated in Appendix IV.1 are insured under the basic plan for the eligible person undergoing treatment with this drug where the payment indications set out in this appendix are fulfilled and where the following conditions are met:
(1) for the reimbursement of Copaxone™ S.C. Inj. Sol (syr) 20 mg/mL (1 mL), in addition to being referred to in subparagraph (2) or (3) of the first paragraph of item 2.3., the eligible person must have begun a treatment and received a reimbursement from the Régie, an insurer or an administrator of an employee benefit plan before 5 July 2018.
Biologic drugs indicated in Appendix IV.1 are insured under the basic plan where the eligible person undergoing treatment with this drug is referred to in one of the cases set out in the first paragraph of item 2.3., where the payment indications set out in this appendix are fulfilled and when the person has begun a treatment and received a reimbursement from the Régie, an insurer or an administrator of an employee benefit plan before the end of coverage of the prescription drug under items 2.2. and 2.3. The date by which the person must have begun a treatment and received a reimbursement is set out in Appendix IV.1.
Notwithstanding the second paragraph, the following biologic drugs indicated in Appendix IV.1 are also insured under the basic plan where the eligible person undergoing treatment with this drug is referred to in one of the cases set out in the first paragraph of item 2.3., where the payment indications set out in this appendix are fulfilled and where the following conditions are met:
(1) for the reimbursement of Enbrel™ S.C. Inj. Sol. (syr) 50 mg/mL and Enbrel™ SureClick™ S.C. Inj. Sol. 50 mg/mL:
(a) in the case of rhumatoid arthritis and ankylosing spondylitis, the eligible person must have begun a treatment and received a reimbursement from the Régie, an insurer or an administrator of an employee benefit plan before 18 August 2017.
(b) in the case of juvenile idiopathic arthritis, the eligible person must have begun a treatment and received a reimbursement from the Régie, an insurer or an administrator of an employee benefit plan before 1 February 2018.
(c) in cases of moderate or severe psoriatic arthritis of the rheumatoid type or of a type other than rheumatoid or a severe form of chronic plaque psoriasis, the eligible person must have begun a treatment and received a reimbursement from the Régie, an insurer or an administrator of an employee benefit plan before 19 August 2020.
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(2) for the reimbursement of Neupogen™ Inj. Sol. 300 mcg/mL (1.0 mL) and Neupogen Inj. Sol. 300 mcg/mL (1.6 mL), the eligible person must have begun a treatment and received a reimbursement from the Régie, an insurer or an administrator of an employee benefit plan before 30 September 2020 without there having been an interruption in the pharmacological treatment;
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