The Canadian Pooling System

The Canadian pooling system, introduced on January 1, 2013, is a private initiative, not governed by legislation, and therefore voluntary. Reserved for insurers and affecting only fully insured plans, this mechanism is independent of the Quebec Drug Insurance Pooling Corporation’s system.

The major difference between the two systems lies in the fact that the Quebec system is mandatory. It is governed by section 43 of the Act Respecting Prescription Drug Insurance,  and the pooling thresholds set by the Corporation and communicated to the Minister each year on November 1st constitute the Terms and Conditions in effect for the following year.

For the participating insurers, the operation of the Canadian mechanism provides protection over and above that of the pooling system in force in Quebec. Indeed, the Canadian threshold’s monetary criteria may be lower than certain thresholds for levels in the Quebec system. Accordingly, the gap between the Canadian and Quebec thresholds would be compensated in such cases.

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