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RAMQ 4516: Patient d'exception Request (Outside Québec)

Prescribers outside Québec use this 3-page request when a Québec-insured patient needs a drug that isn't on RAMQ's Liste des médicaments, or an exception drug for an unlisted indication. It is the out-of-Québec version of form 3996. RAMQ covers the drug only when the condition is serious and chronic, the need is particular and the drug is a last resort.

Who completes it

The out-of-Québec prescriber completes and signs it. A first request needs every section except 8 and 9, a renewal needs sections 1 to 4, 8, 10 and 11, and outpatient end-of-life palliative care requests use sections 4, 7, 10 and 11.

Submitting and payment

How to submit it
Save the completed form and send it with supporting documents through RAMQ's secure online form for out-of-Québec professionals. RAMQ mails its decision or any request for more information.

Good to know

  • Attach relevant clinical test results, including a specialist investigation report where applicable, for example imaging, T-scores or laboratory values.
  • Chronic means inherent to the disease, recurrent or episodic, a complication of a chronic condition, or lasting over 3 months. Serious acute infections and outpatient end-of-life symptom care are exempt.
  • Drugs not marketed in Canada are ineligible even when Health Canada's Special Access Program allows them, and reference biologics with a biosimilar, erectile dysfunction and weight-loss drugs are excluded.
  • Before applying, you may check whether a manufacturer assistance program supplies the drug. If that program ends, the patient must still meet every condition of the measure for RAMQ coverage.

Get the official form

Download the current version from the source each time; forms change without notice.

Demande d'autorisation de paiement (hors Québec) – Mesure du patient d'exception

Request for Payment Authorization (Outside Québec) – Exceptional Patient Measure

Official pagePDF

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

What's the difference between RAMQ forms 4516 and 4515?

Form 4515 covers exception drugs used for an indication recognized for payment in Annex IV of the Liste des médicaments. Form 4516 is for the exceptional patient measure: drugs not on the List, or exception drugs for an indication the List doesn't recognize. Both are for prescribers outside Québec who haven't joined the health insurance plan.

What does RAMQ need for a renewal on form 4516?

Tick the renewal box and complete sections 1 to 4, 8, 10 and 11. Section 8 asks you to describe the benefits observed with the drug against the measurable benefits expected in the first request. RAMQ refuses a renewal when those expected benefits have not been achieved.

How long does a patient d'exception request take?

RAMQ processes exceptional patient requests in order of receipt and warns that they can take longer than exception-drug requests because each one is assessed case by case. Out-of-Québec prescribers receive the decision, or a request for more information, by mail, so complete files with supporting results avoid extra rounds.