Thank you for the question.
That would mean not aggregating all the provinces as we have done. You are asking if the RAMQ model could be used everywhere.
I would say that it all comes down essentially to one's capacity to negotiate. Someone gave the example of U.S. veterans. If all the provinces came together, then that group's strength and the volume of drugs are what gives it negotiating clout.
The RAMQ in Quebec is able to negotiate because it manages a universal program which is much more extensive than that of many of the other provinces. That is the first factor to take into account.
Here is the second. You know very well what is also going on in Quebec, i.e., in terms of pharmacists' dispensing fees. You will have followed the debate. Dispensing fees in Quebec range from 8% to 90% of a drug's price. The RAMQ, because it buys huge quantities and has total control over its formulary, is able to negotiate and impose certain rules.
If we did indeed have a national program, and this is what we're trying to prove in our study, as long as all the provinces have negotiating power, this national program would wield enough clout that we would be able to save $4 billion post-negotiation and enjoy price reductions, as well as provide much more extensive coverage. What's more, we could cover everyone, which is currently not the case.