An exception drug is a drug that is not usually covered by the public drug insurance plan (RPAM). The measures implemented at the RAMQ for exceptional drugs allow the entire population to obtain coverage for certain drugs if they are used in compliance with the indications recognized by the Institut national d'excellence en santé et services sociaux (INESSS). Exception drugs are now a large and constantly increasing part of total spending on prescription drugs.

For the RPAM, one of the ways to control this increase is to reimburse these drugs according to pre-established rules. Currently, the system automatically processes around 20% of requests while the rest are directed to a case-by-case analysis, which generates delays.

This project is to help the business sector respond more quickly to requests for approval of exception drugs. A tool will be developed based on 15 years of data collected by the current system, and will aim to increase the number of requests processed automatically.