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  • Introduction


    A cancer diagnosis is scary. In addition to the trying to understand the disease and what it means to you and your family you must also navigate your treatment options.  If your treatment involves drugs, you may have the additional step of determining your available drug coverage.

    Access to cancer drugs in Canada varies significantly among provinces, resulting in inequities across the country.  Some provinces have cancer agencies that fund cancer treatments. In others, cancer treatment is funded on a hospital by hospital basis. Many provinces fund IV medications, but only four provinces fund oral medications. As a result, oral drugs are more typically paid for by private drug plans or cash. Certain new IV oncology drugs have been approved by Health Canada, but not approved for provincial funding, which leaves many patients in limbo. The necessary drug is available — sometimes even in a hospital — but there is no one to cover the cost.

    If you have an employer sponsored health care program, it may provide coverage in some cases; however for a number of reasons it can also be difficult to understand available alternatives.

    For example, many private insurers cover oral cancer medications and not IV medications, because they believe the Canadian Health Act requires that medically necessary IV drugs should be dispensed in hospitals and covered through hospital budgets.

    Some private plans pay for treatment if the drug is not delivered in hospital, which in part explains the growing number of private infusion clinics in Canada.

    Because of this complexity, the above drug coverage tree is intended to provide you with a guide to navigating your drug coverage in Canada.

    Helpful external links:

    There are a few Canadian programs that help patients navigate what drug coverage is available to them

    1. Ask your oncologist or contact the drug company to see if they have a patient assistance program that offers treatment delivery in a private clinic.  For more information on programs:

    2. http://www.drugcoverage.ca/

    3. In Ontario, Cancer Care Ontario offers Cancer Drug Benefits Navigator (CDBN) a free telephone service helping patients, family members, caregivers and health professionals figure out reimbursement options for all cancer and cancer-related drugs. For more information:

      http://www.cancercare.on.ca/cms/one.aspx?pageId=11836

    [Note: Ontario is the only province to offer this kind of navigation service]