The Régie de l'assurance maladie du Québec (RAMQ) has informed stakeholders that as of June 30, 2022, physicians will have to submit their requests for exceptional patient and exceptional medication (patient d’exceptions and medicament d’exception) through an online portal (the “PME Portal”). The prior method of submitting paper or PDF version, including via faxes will no longer be accepted.

According to the RAMQ, physicians can delegate the access to the online PME portal but only to “authorized collaborators”.

The question has arisen as to who may be considered an “authorized collaborator”.

The RAMQ Infolettre 025 [PDF] (available in French only) (dated May 5, 2022) provides:

Vous pouvez créer des équipes et déléguer la rédaction des demandes à des collaborateurs autorisés. Chaque collaborateur a un nom d’utilisateur et un mot de passe distinct. Notez que le nom d’utilisateur et le mot de passe sont confidentiels et ne peuvent être partagés à quiconque.


You can create teams and delegate the drafting of requests to authorized collaborators. Each collaborator has a separate username and password. Note that the username and password are confidential and cannot be shared with anyone [our translation and emphasis].

In this newsletter, there is no additional precision regarding who is an authorized collaborator.

Nevertheless, other related documents, including an FAQ linked within the RAMQ Infolettre 25, specify that only physician staff may use the online portal on behalf of physicians.

For example, in addressing physicians, the Service en ligne Patient et médicaments d'exception (available in French only) provides:

Vous pouvez nous demander de donner accès au service en ligne PME à l’un des membres de votre personnel (administratif ou infirmier). […] Assurez-vous que la personne à qui vous voulez donner l’accès au service en ligne PME est sous la direction ou le contrôle de votre clinique ou de votre établissement. Sinon, nous ne lui donnerons pas l’accès.


You can ask us to give access to the SME online service to one of your staff members (administrative or nursing). […] Make sure that the person to whom you want to give access to the PME online service is under the direction or control of your clinic or establishment. Otherwise, we will not give them access [our translation and emphasis].

Moreover, RAMQ Infolettre 278 [PDF] (available in French only) (dated February 17, 2022) also addressing physicians provides:

Vous pouvez aussi déléguer l’accès du service en ligne PME à un membre de votre personnel. Vous l’autoriserez ainsi à accomplir certaines tâches en votre nom. Pour tout prescripteur autre qu’un pharmacien, assurez-vous que cette personne fait partie de votre clinique ou de votre établissement.


You can also delegate access to the SME online service to a member of your staff. This will authorize them to perform certain tasks on your behalf. For any prescriber other than a pharmacist, ensure that this person is part of your clinic or establishment [our translation and emphasis].

Currently, patient programs designed by the pharmaceutical industry and often administered by specialty vendors provide certain support for the completion of the patient d’exception and medicament d’exception forms, which are administratively complex and can take considerable time to complete. The assistance with and/or preparation of these reimbursement forms fills a patient care gap. This gap is not assumed by other stakeholders within the health ecosystem, including, e.g., the RAMQ. Without assistance from patient support programs, vulnerable patients may have difficulty accessing the medications which have been prescribed by their physicians.

Therefore, while the RAMQ’s stated reason for the change is to improve processing time, the restriction to physicians and their “authorized collaborators” may in fact create new delays.

Importantly, the RAMQ has not clarified what stakeholders can do to support physicians in the completion of the form. In an evolving legal environment, it is critical that the RAMQ provide clear and predictable rules for all stakeholders.