Quebec RAMQ Coverage for Psychedelic Therapy

Quebec is the only Canadian province with established public-funding precedent for psychedelic-assisted therapy. In December 2022, Drs. Houman Farzin (palliative psychiatrist, Jewish General Hospital, McGill) and Jean-François Stephan billed RAMQ (Régie de l'assurance maladie du Québec) for SAP (Health Canada's Special Access Program)-approved psilocybin-assisted psychotherapy delivered to a Quebec patient with end-of-life distress. RAMQ subsequently modified medical billing codes to permit further public claims for SAP-approved Quebec psilocybin patients. This was the first publicly funded psychedelic therapy in Canada — and it remains psilocybin-specific. RAMQ has NOT extended public funding to ketamine, Spravato, or MDMA-AT at this time. INESSS (Institut national d'excellence en santé et services sociaux, Quebec's drug-evaluation body) recommended against listing Spravato on the RAMQ formulary in November 2020. The Quebec RAMQ pathway is real but capacity-limited and dependent on physician engagement. This article walks through the eligibility, the practical pathway, and what RAMQ does and does not cover.

Key takeaways

• Quebec RAMQ has established public funding for SAP-approved psilocybin-assisted therapy via the December 2022 Farzin/Stephan precedent.
• RAMQ modified medical billing codes subsequently to permit further public claims for SAP-approved Quebec patients.
• Eligibility framework: SAP authorization in place; Quebec residency with valid RAMQ coverage; eligible indication (typically end-of-life distress; expanded case-by-case); Quebec-based prescribing physician willing to apply for SAP and bill RAMQ.
• Coverage scope: psilocybin-assisted therapy specifically. Ketamine, Spravato, and MDMA-AT are NOT covered by RAMQ at this time.
• INESSS recommended against Spravato listing in November 2020 (Canadian Drug Expert Committee aligned recommendation).
• CNESST Quebec (workers' compensation) is a separate pathway — case-by-case for compensable PTSD or chronic pain.
• Bill 21 (loi 21, 2009) reserves psychotherapy as a regulated act — affects who can deliver the psychotherapy component.
• Capacity-limited: Quebec physicians applying for psilocybin SAP and billing RAMQ remain a small subset of the broader Quebec psychiatric/palliative landscape.

The December 2022 Farzin/Stephan precedent

The pivotal Quebec event happened in two phases:

June 2022: Drs. Houman Farzin (palliative psychiatrist, Jewish General Hospital, McGill University) and Jean-François Stephan delivered SAP-approved psilocybin-assisted psychotherapy to a Quebec patient with end-of-life distress under Health Canada Special Access Program authorization.

December 2022: Following extensive evidence-letter submission (cosigned by 15 Quebec colleagues), Drs. Farzin and Stephan successfully billed RAMQ for the psilocybin-assisted psychotherapy work — the first publicly funded psychedelic therapy in Canada.

Subsequently: RAMQ modified medical billing codes to permit further public claims for SAP-approved Quebec patients receiving psilocybin-assisted psychotherapy.

The TheraPsil documentation of this case is at https://therapsil.ca/quebec-first-province-to-cover-costs-of-psilocybin-assisted-psychotherapy-done-by-two-physicians/.

Eligibility — what the Quebec RAMQ pathway requires

A Quebec patient pursuing the RAMQ public-funding pathway for psilocybin-assisted therapy must meet several requirements:

1. SAP authorization in place

Health Canada Special Access Program authorization is the prerequisite. The SAP is patient-specific and physician-initiated:

• Quebec-based prescribing physician (typically psychiatrist, palliative-care physician, or psychiatric NP) submits the SAP request
• Documentation of conventional treatment failures
• Eligible indication (typically end-of-life distress; case-by-case for TRD, AUD, demoralization, others)
• Health Canada review (typically 2–8 weeks in 2026)

For the SAP detail: Health Canada SAP for Psilocybin and How to Access Psilocybin Therapy in Canada.

2. Quebec residency with valid RAMQ coverage

Standard provincial residency and Quebec health insurance coverage requirements.

3. Eligible indication

The Farzin/Stephan precedent was specifically for end-of-life distress — the foundational SAP indication. RAMQ public funding for SAP-approved Quebec patients applies most clearly to this profile. Other indications (TRD, AUD, demoralization in serious illness) may apply case-by-case under modified billing codes; verify with the Quebec prescribing physician and RAMQ.

4. Quebec-based prescribing physician willing to apply and bill

The bottleneck most patients face. The Quebec community of physicians who have applied for psilocybin SAP and billed RAMQ remains relatively small. Resources:

• Drs. Farzin and Stephan (Jewish General / McGill)
• Other Quebec psychiatrists and palliative-care physicians with SAP experience
• TheraPsil directory of trained Canadian clinicians (some Quebec-based)
• MAPS Canada Quebec providers

For the Quebec provider landscape detail: Psilocybin Therapy in Quebec.

What RAMQ does NOT cover

RAMQ public funding for psychedelic-assisted therapy is psilocybin-specific. Other psychedelic substances are not RAMQ-covered:

Ketamine — not covered

• Off-label generic ketamine (IV/IM/sublingual) for psychiatric use is not on the RAMQ formulary
• Spravato (esketamine): INESSS recommended against listing in November 2020. Not on RAMQ. Quebec patients seeking Spravato pursue private insurance prior auth (Manulife, Sun Life, Green Shield, Canada Life PSHCP for federal public servants — see PSHCP Spravato Coverage)
• CNESST Quebec is a separate pathway for compensable conditions — see Workers' Compensation for Psychedelic-Assisted Therapy
• Quebec hospital programs including CHUM, Jewish General (Montreal Model of ketamine-assisted therapy by Dr. Kyle Greenway), and Douglas Mental Health University Institute deliver ketamine work with various funding sources — see Ketamine Therapy in Montreal

MDMA-AT — not covered

The December 2022 Farzin/Stephan RAMQ precedent was psilocybin-specific and has NOT been extended to MDMA-AT. Reasons:

• Indication mismatch: the Farzin/Stephan precedent was for end-of-life distress; MDMA-AT's foundational indication is PTSD
• No equivalent Quebec advocate has yet pursued an MDMA-AT RAMQ billing precedent at scale
• Lower SAP volume for MDMA (~41 cumulative through Feb 2024) versus psilocybin (~176)

For Quebec MDMA-AT context: MDMA-Assisted Therapy in Quebec.

Spravato — INESSS non-listing

INESSS (Institut national d'excellence en santé et services sociaux), Quebec's drug-evaluation body, recommended against listing Spravato on the RAMQ formulary in November 2020 (INESSS Spravato extract notice). The Common Drug Review (federal) issued an aligned recommendation. Quebec Spravato access is essentially private prior auth or out-of-pocket.

Bill 21 — psychotherapy as a reserved act

Quebec's Bill 21 (loi 21, 2009) reserves psychotherapy as a regulated act. The implication for psychedelic-assisted therapy:

The psychotherapy component must be delivered by:

• Physicians
• Psychologists (members of OPQ — Ordre des psychologues du Québec)
• Members of designated professional orders holding a psychotherapy permit from OPQ

For RAMQ-billed psilocybin-assisted therapy specifically, the physician role (the medical prescription, supervision, and dosing-day medical responsibility) is filled by the Quebec prescribing physician; the psychotherapy component must be delivered by Bill 21-eligible providers. The Farzin/Stephan model includes both the medical and psychotherapy components within the physician role.

For the broader Bill 21 framework, see Psilocybin Therapy in Quebec.

How ATMA CENA supports Quebec RAMQ-pathway patients

ATMA CENA's role for Quebec RAMQ-pathway psilocybin patients:

• The medical SAP application is initiated by the Quebec prescribing physician — ATMA CENA does not directly initiate
• ATMA CENA supports preparation and integration through the three-phase psychedelic-assisted therapy model
• The coordinated care model is particularly valuable for Quebec patients given Bill 21: the Quebec-based therapist (physician, psychologist, or OPQ permit holder) remains primary, while ATMA CENA's clinical infrastructure supports the broader frame
• ATMA CENA's Montreal member clinic (Clinic Dr. Bita) operates bilingually; specific RAMQ-pathway psilocybin scope at Clinic Dr. Bita should be confirmed at intake
• ATMA CENA does not directly bill RAMQ. RAMQ billing is initiated by the Quebec-based prescribing physician under the Farzin/Stephan precedent and modified billing codes

Frequently asked questions

Does RAMQ cover psychedelic-assisted therapy? Yes for psilocybin-assisted therapy via the December 2022 Farzin/Stephan precedent for SAP-approved Quebec patients. No for ketamine, Spravato, or MDMA-AT — RAMQ has not extended public funding to other psychedelic therapies.

Why does Quebec cover psilocybin but not other psychedelic substances? The December 2022 Farzin/Stephan precedent was specifically for end-of-life distress — psilocybin's foundational SAP indication. RAMQ modified billing codes for that specific clinical context. Other substances would require analogous precedents to extend public funding; none have been established.

What's the eligibility for the RAMQ psilocybin pathway? SAP authorization in place; Quebec residency with valid RAMQ coverage; eligible indication (typically end-of-life distress); Quebec-based prescribing physician willing to apply for SAP and bill RAMQ.

Where do I find a Quebec physician for the RAMQ pathway? Drs. Farzin and Stephan (Jewish General / McGill); other Quebec psychiatrists and palliative-care physicians with SAP experience; TheraPsil directory; MAPS Canada Quebec providers.

Why doesn't Quebec cover Spravato? INESSS recommended against listing in November 2020 due to uncertain demonstrated benefit. Common Drug Review issued an aligned recommendation. Quebec patients seeking Spravato pursue private insurance prior auth or out-of-pocket payment.

What if I need ketamine therapy in Quebec — is it covered? Not by RAMQ for psychiatric off-label use. Quebec ketamine providers (CHUM, Jewish General Montreal Model, Douglas Mental Health, private clinics) operate with various funding sources — usually private insurance or out-of-pocket. CNESST (workers' compensation) reviews case-by-case.

Can my Quebec doctor bill RAMQ for psilocybin work like Drs. Farzin and Stephan? The Farzin/Stephan precedent established that RAMQ modified billing codes to permit such claims. In practice, Quebec physicians applying for psilocybin SAP and billing RAMQ remain a small subset. Capacity is limited.

Is the RAMQ pathway only for end-of-life patients? The Farzin/Stephan precedent was for end-of-life distress. Modified billing codes may apply to other SAP-eligible indications case-by-case (TRD, AUD, demoralization in serious illness). Verify with the Quebec prescribing physician and RAMQ.

What about MDMA-AT for Quebec patients? Not RAMQ-covered. Quebec MDMA-AT patients pursue SAP-pathway out-of-pocket payment unless covered through VAC (service-related PTSD) or CNESST (compensable conditions). See MDMA-Assisted Therapy in Quebec.

How does ATMA CENA's Montreal member clinic fit? ATMA CENA's Quebec member clinic is Clinic Dr. Bita (1255 Avenue Greene, Westmount). Operating bilingually, the clinic supports preparation and integration via coordinated care in coordination with Quebec prescribing physicians. Specific RAMQ-pathway psilocybin scope at Clinic Dr. Bita should be confirmed at intake.

What about CNESST workers' compensation? CNESST is Quebec's workers' compensation body — separate from RAMQ. CNESST reviews ketamine and other psychedelic-assisted therapy claims case-by-case for compensable PTSD or chronic pain. Quebec service-connected populations (Sûreté du Québec, municipal police, paramedics, firefighters) may pursue CNESST coverage.

Will Quebec eventually extend RAMQ coverage to MDMA-AT or ketamine? Possible. Future expansion would require additional billing-code modifications and Quebec-side advocacy. The December 2022 Farzin/Stephan psilocybin precedent took years of advocacy work to establish; analogous precedents for MDMA-AT or ketamine could follow if Quebec physicians pursue them.

Sources

1. TheraPsil — Quebec first province to cover psilocybin therapy: https://therapsil.ca/quebec-first-province-to-cover-costs-of-psilocybin-assisted-psychotherapy-done-by-two-physicians/
2. INESSS — Spravato Quebec recommendation (November 2020): https://www.inesss.qc.ca/en/themes/medicaments/drug-products-undergoing-evaluation-and-evaluated/extract-notice-to-the-minister/spravato-5429.html
3. Quebec Bill 21 (2009, c.28) — psychotherapy as a reserved act: https://www.publicationsduquebec.gouv.qc.ca/fileadmin/Fichiers_client/lois_et_reglements/LoisAnnuelles/en/2009/2009C28A.PDF
4. Health Canada — SAP psychedelic-assisted psychotherapy: https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/announcements/requests-special-access-program-psychedelic-assisted-psychotherapy.html
5. CDA-AMC — Spravato CDEC Final Recommendation (December 2020): https://www.cda-amc.ca/sites/default/files/cdr/complete/SR0621%20Spravato%20-%20CDEC%20Final%20Recommendation%20December%2018,%202020_for%20posting.pdf
6. RAMQ — List of Medications: https://www.ramq.gouv.qc.ca/en/citizens/prescription-drug-insurance/find-out-whether-a-drug-covered
7. ATMA CENA — Montreal member clinic: https://psychedelic.healthcare/

Related articles

• Insurance Coverage for Psychedelic-Assisted Therapy in Canada
• PSHCP / Canada Life Spravato Coverage
• Provincial Drug Plans for Psychedelic Therapy
• VAC Coverage for Psychedelic-Assisted Therapy
• Workers' Compensation for Psychedelic-Assisted Therapy
• Psilocybin Therapy in Quebec
• MDMA-Assisted Therapy in Quebec
• Ketamine Therapy in Montreal

Last updated: 2026-05-06