A federal public servant in Quebec with Stage 4 metastatic breast cancer is paying out of pocket for a drug costing up to $12,000 monthly after Canada Life denied her insurance coverage under the federal plan on June 19, 2026.
Sophie Djeme-Mi Koumazock, a 43-year-old mother of four, was prescribed Truqap after her previous medication stopped controlling her cancer.
Although Quebec's provincial health insurance board (RAMQ) covers the treatment under exceptional circumstances, the Public Service Health Care Plan (PSHCP) excludes it from coverage.
Jurisdictional Gap Leaves Patient Without Access
The denial stems from a unique jurisdictional gap in Quebec. Under provincial law, private insurers must match RAMQ's coverage floor.
However, the federal PSHCP operates under federal jurisdiction and is exempt from meeting Quebec's provincial minimums.
Because federal workers must use their employer's plan, they are barred from accessing RAMQ directly while remaining unprotected by provincial minimum coverage rules.
In its refusal letter, insurer Canada Life stated that its program requires reviewing factors including efficacy, safety, and cost effectiveness.
The Treasury Board of Canada, which manages PSHCP policy, confirmed Truqap is not an eligible drug under its prior authorization program, explaining that the federal plan is meant to supplement provincial health plans rather than replicate basic coverage.
Djeme-Mi Koumazock expressed disbelief over the regulatory discrepancy that leaves her without access to treatment available to other Quebec residents.
“It’s destroyed me. I didn’t know what to do,” said Djeme-Mi Koumazock.
“I need this medication to survive, I never would have thought they would hit me with a no,” she added.
She reaffirmed her determination to continue her fight: “I want to live.”
Djeme-Mi Koumazock also raised questions about fairness across the province: “Why, between two Quebecers, could one have access to this medication and not me?”
Medical specialists confirmed that switching medications is necessary when preliminary lines of treatment fail.
“When the medication we are giving stops [working] … and we lose the control, we have to change the treatment,” said Dr. Brigitte Poirier, surgical oncologist at CHU de Québec-Université Laval.
Poirier emphasized the medical team's goal to support young patients with families: “It’s not easy for someone [who is] like 43 years old with young kids.
We want to give them time.”
Official channels noted the rarity of double insurance denials within the province.
“It’s very unlikely that two different insurers refuse to reimburse a medication that RAMQ would accept to cover and, to our knowledge, a situation of this kind has never been brought to our attention,” said a RAMQ representative.
To afford the medication, Djeme-Mi Koumazock and her partner are dipping into their personal savings while awaiting a secondary insurance decision from her partner's provider, Beneva.
