Exceptional access to pharmaceuticals in Quebec hospitals: insights from members of medical necessity committees

Abstract Objectives The aim of this article is to contribute to a nuanced and empirically grounded understanding of exceptional access as practiced in Quebec from 2016 to 2024. We seek to examine the clinical, social, and political stakes of this program by integrating diverse perspectives, notably those of members of hospital pharmacology committees responsible for decisions regarding “Nécessité Médicale Particulière” (NMP), or Particular Medical Necessity in English. Methods A total of 15 semi-structured interviews were conducted across seven healthcare territories and hospital-based establishments. These discussions offered insights into pharmaceutical care practices, the organizational structure and functioning of NMP review committees within the establishments, and the criteria informing their decision-making processes. Interviewees also shared concerns, tensions, and reflections regarding committees’ role and the broader healthcare system context. Key findings Our analysis reveals substantial heterogeneity in practices across institutions. This variability has contributed to perceived inequities in medication access. Moreover, the absence of systematic clinical and economic data collection has, according to participants, generated uncertainty discomfort, further exacerbating the perceived inequities in the implementation of this exceptional access program. Conclusion The findings presented in this article document real-world practices related to the management of NMP requests within healthcare establishments and highlight perceived inequities, as well as the ambiguous role institutions are compelled to assume when addressing so-called innovative and promising therapies.