1. Who pays for cancer drugs in Ontario?
There are several different payment sources for cancer drugs, depending on the medication, and how and where it is delivered.
Intravenous (IV) cancer drugs
The New Drug Funding Program (NDFP) provides at least 75% of the overall IV cancer drug funding. NDFP funding is for new and approved IV cancer drugs that are administered in hospitals.
Hospital budgets provide up to 25% of the funding spent, on older IV cancer drugs that were approved before the NDFP was established.
Some new and expensive IV drugs that are not funded through the NDFP are available for private payment (either third-party insurance or self-pay), out of province, or at a private clinic. Some patients are beginning to have these drugs administered at Ontario hospitals under the care of their own oncologists for private payment. Each hospital decides whether to administer unfunded IV cancer drugs.
The NDFP does not fund IV cancer drugs administered in private clinics.
For more information:
Community-based Medications
The Ontario Drug Benefit Program covers non-intravenous cancer drugs (i.e. pill form and injections under the skin) for seniors and people on family benefits.
The Trillium Drug Program assists Ontario residents who have high prescription drug costs relative to their income.
Other people have private insurance or pay out of pocket.
For more information:
2. What is the New Drug Funding Program (NDFP)?
The New Drug Funding Program (NDFP) is one of four publicly funded drug programs under the Ontario Public Drug Programs (OPDP). Administered by Cancer Care Ontario, the NDFP funds new, and often very expensive, cancer drugs. The program was created in 1995 to ensure that Ontario patients have equal access to high-quality IV cancer drugs.
Historically, each hospital paid for its own IV cancer drugs, which led to unequal access at different hospitals across the province. Decisions were not always based on evidence about medical benefit and value for money. Now, drugs funded within the NDFP are supported by evidence from clinical guidelines, which ensure they are delivered according to the best standards of care.
The NDFP covers about 75% of the overall cost of all IV cancer drugs in Ontario. Hospitals cover the remaining 25%, on older IV cancer drugs that were approved before the NDFP was established.
3. What drugs are covered by the New Drug Funding Program?
The list of NDFP funded drugs, and the indications for which they are covered, is posted on this Web site.
4. Which cancer drugs are funded in Ontario?
More information about funded IV cancer drugs is available on this web site.
Information about other medications, including oral or community-based cancer drugs can be found on the following web sites:
If you have private insurance, check with your insurer about which drugs are covered by your plan. 5. Who decides what drugs are paid for by the provincial programs (ODB, Trillium, NDFP)?
The final funding decision is made by the Executive Officer (EO) of the Ministry's Ontario Public Drug Programs, based on a recommendation from the Committee to Evaluate Drugs (CED), the independent expert advisory committee to the Ministry of Health and Long-Term Care.
The recommendation about whether to fund both oral and intravenous cancer drugs, as with any drug, must be based on the degree of medical benefit they provide weighed against their cost. For cancer drugs, this is done through a subcommittee made of members of the CED and experts from CCO, which include cancer specialists, physicians, health economists, pharmacists and ethicists. The joint CED/CCO subcommittee looks at the evidence on a drug's clinical and cost-effectiveness, and makes a recommendation to the CED. In turn, the CED makes a recommendation to the Executive Officer whether a drug should be funded. This process ensures that the decisions are based on the best available scientific evidence.
6. Why are some drugs covered in other provinces but not in Ontario?
In Canada, health care funding largely falls under provincial jurisdiction. Each province makes its own decision about which drugs it will fund based on its priorities and means.
An interim review involving all provinces (except Quebec) is currently taking place to see whether it is possible to have a single cancer drug review process for all the participating provincial jurisdictions. Although participating jurisdictions have access to listing recommendations, the final funding decision still rests with each participating jurisdiction.
7. Why are some drugs not covered in Ontario even though they have been approved by Health Canada?
Health Canada and the provinces approve different aspects of a drug. Health Canada approval (called Notice of Compliance) does not automatically mean a drug will be paid for by a provincial funding program. Health Canada evaluates a product's safety and efficacy, and approves drugs for sale and marketing in Canada. However, Health Canada does not consider the relative clinical benefits and cost effectiveness of a drug in comparison with other drugs that already are available and funded. This latter part is up to each province. The provinces are the ones who pay for drugs. Ontario conducts a more detailed evaluation of the medical effectiveness of each drug than Health Canada. The province compares the medical benefits of a drug to those of other funded drugs, and weighs the cost of drugs against their benefits.
Before a new drug can be considered by most provincial drug plans, the manufacturer must file a submission to the national Common Drug Review (CDR) process. In Ontario, the manufacturer then must file a submission to the Ontario Public Drug Programs.
For hospital-based, intravenously administered drugs, that are considered for funding through the New Drug Funding Program (NDFP), a submission to the CDR is currently not required. Submissions to NDFP are made directly to the Ontario Public Drug Programs.
There is an interim single review process for new cancer drugs under way in Canada, involving all provinces except Quebec. As of March 2007, all participating provinces make a single submission to Ontario's review process to improve consistency and reduce duplication in decision making about new drugs. During this process, the CDR will not be accepting submissions for community based oral or injectable cancer drugs. Submissions of community-based drugs for consideration of funding under the Ontario Drug Benefit or Trillium Drug Programs should be directed to the Ministry's Ontario Public Drug Programs until further notice.
For more information:
Ontario's drug review process:
8. Whom do I contact to find out whether a new drug is under consideration for funding in Ontario?
If you know which pharmaceutical company is distributing the drug in Canada, you can contact them directly to ask whether they have applied, or plan to apply, to have the drug funded in Ontario. Alternatively, if you do not know which company to contact, the Ontario Public Drug Programs of the Ministry of Health and Long-Term Care, or Cancer Care Ontario may know whether a submission has already been made for a particular drug.
E-mail: Ontario Public Drug Programs
E-mail: Cancer Care Ontario
9. I have Health Canada approval through the Special Access Program. Does that mean my drug will be paid for by one of the provincial funding programs?
The Special Access Program is a mechanism to allow patients to have access to drugs that have not yet been approved for sale in Canada. Access is decided on a patient-by-patient basis. This is known as compassionate access. It is not a funding approval program. The cost of drugs obtained through the Special Access Program may be covered by the patient, the hospital or an insurance plan. In some cases, the manufacturer may provide the drug free of charge.
For more information:
10. Who can help me find the right program to pay for my cancer treatment?
Cancer drugs can be covered by public programs (Ontario Drug Benefit, Trillium, and New Drug Funding Program) or by private insurance. However, not all drugs are covered by public and private reimbursement programs. Your physician and cancer centre pharmacist will know whether your intravenous cancer drug is funded by the hospital directly or the New Drug Funding Program (NDFP), and will complete the required paperwork for the NDFP. These people can also help you sort through other funding options. Your nurses and social worker may be able to assist you as well.
For more information:
11. Why does it take so long for a new drug to get approved for funding in Ontario?
Several steps are taken in the approval process for drugs that are to be used in cancer. Whether it is a new cancer drug, or an older drug with a new indication for cancer, steps need to be taken to ensure it is safe, medically effective and provides value for its cost. First, Health Canada must approve a drug for sale in Canada based on its safety and efficacy. The manufacturer then makes a submission to the provincial government's Ontario Public Drug Programs (OPDP). In turn, the OPDP then allows the drug to undergo a more in-depth, independent evaluation.
Ontario has a good process for evaluating new and expensive cancer drugs based on the best scientific evidence. For cancer drugs, this is done through an independent committee of Cancer Care Ontario and the Committee to Evaluate Drugs (CED) made up of cancer experts, physicians, health economists, pharmacists and ethicists. The team look at the evidence on a drug's clinical effectiveness, as well as cost effectiveness, and makes a recommendation to the CED. In turn, the CED makes a recommendation to the Executive Officer whether a drug should be funded. This process ensures that the decisions are based on the best available scientific evidence. Is also ensures more consistent decisions for oral and intravenous drugs and those covered by different public programs.
For further information about Ontario's drug review process :
For further information about the Common Drug Review process :
12. What are the reasons a new drug or indication might not be approved for funding?
The decision about whether to fund both oral and intravenous cancer drugs, as with any drug, is based on the degree of medical benefit each provides, weighed against overall cost. There are many reasons a new drug or indication may not receive funding approval. Several reasons for non-approval include: a lack of high-quality evidence of its effectiveness; the drug's medical benefit might be marginal; the drug may not offer enough of a benefit over treatments that are already available; the potential dangers or side effects of the drug may outweigh its benefits; or the drug may not provide enough of a benefit to make its cost worthwhile.
Ontario's drug review process is in place to ensure that drug funding decisions are made (and Ontarians' health care dollars are spent) responsibly and equitably. And that decisions are based on the best available evidence on a drug's effectiveness and cost effectiveness.
13. How much money is spent on cancer drugs in Ontario each year?
In 2007/08, the New Drug Funding Program and Ontario Drug Benefit program, combined, covered more than $275-million in cancer drugs. This number does not include money spent on cancer drugs by hospitals, and private payers such as individuals and personal insurance companies.
Spending on cancer drugs will continue to grow in the years to come because of the number of new drugs available and the introduction of very expensive therapies. As well, there is the complexity and intensity of new cancer drugs, and the growing rate of cancer. Over the next 10 years, 728,148 more people in Ontario will be diagnosed with cancer. That means 33.8% more people will have cancer in 2015 than today.
However, even with these increases, the province spends less on cancer drugs than it spends on drugs for some other chronic diseases – even though the cost of the drugs for some of these other diseases may be lower, these drugs are much more widely used.
14. Why are cancer drugs so expensive?
Drug prices are set by manufacturers. The price takes into account the costs behind the research and development of the drug. As well, there are manufacturing costs, supply and demand, and other market and financial considerations. In Canada, drug prices are controlled by the Patented Medicine Prices Review Board (PMPRB), an independent quasi-judicial body established by parliament in 1987 under the Patent Act. The PMPRB is responsible for limiting the prices set by manufacturers for all non-prescription and prescription patented drugs sold in Canada. The PMPRB's primary role is to protect Canadians against excessive pharmaceutical prices.
For further information about the Patented Medicine Prices Review Board :
15. What is Cancer Care Ontario's role in the drug approval process?
Cancer Care Ontario and the government have a joint process for reviewing and approving new cancer drugs funded by the New Drug Funding Program (NDFP), Ontario Drug Benefit Program (ODB) and Trillium Drug Program. An independent subcommittee combines experts from CCO and from the Committee to Evaluate Drugs (CED) to evaluate new cancer drugs. This arms-length subcommittee made up of cancer experts, physicians, health economists, pharmacists and ethicists looks at the evidence on a drug's clinical and cost-effectiveness. They then make a recommendation to the CED. In turn, the CED makes the final recommendation to Ministry’s Executive Officer about whether a drug should be funded.
Cancer Care Ontario also administers the New Drug Funding Program, which is funded by the Ministry of Health and Long-Term Care.
16. How do patients get access to drugs that the Ontario government does not pay for?
Patients usually receive such drugs either out of province, or at a private clinic for private payment. Some patients are now beginning to have these drugs infused in hospitals, under the care of their own oncologist, through some form of private payment. Each hospital must decide whether they will administer these drugs. Cancer Care Ontario has worked with various provincial stakeholders to develop recommendations to the Ministry regarding a standard approach to providing new unfunded intravenous cancer drugs in Ontario hospitals for private payment.
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