Three steps are required before a cancer drug becomes a publicly-funded benefit in Canada:
Health Canada provides federal market authorization to sell a drug.
The clinical effectiveness and cost effectiveness of a drug are evaluated through the pan-Canadian Oncology Drug Review. This process considers information and perspectives from manufacturers, oncologists, health economists, and patients.
Each province or territory then makes its own funding decisions, where the issue of affordability must be considered.
Prescription drug costs are a significant challenge to the sustainability of Canadian health insurance programs. Each Canadian province has its own programs to guide decision making on new – and often very costly – therapies.
In a public system, we have a dual responsibility – delivering high-quality care to patients and spending healthcare dollars wisely to produce the greatest value for patients and society.
Cancer Drug Funding and Decision Making in Ontario
Ontario has a rigorous process for evaluating drugs. It includes an explicit consideration of a drug’s safety, as well as its clinical and cost effectiveness. This process also incorporates patient submissions for drugs to be reviewed and considered for funding.
The pan-Canadian Oncology Drug Review (pCODR) was established in 2011. Both the Ministry of Health and Long-Term Care (ministry) and Cancer Care Ontario (CCO) are partners in the pCODR process, along with other ministries of health and cancer agencies.
Pharmaceutical manufacturers and provincial disease site groups initiate new drug funding requests via the pCODR process.
In Ontario, pCODR recommendations are reviewed by the Committee to Evaluate Drugs (CED). The committee then makes a funding recommendation to the Executive Officer of the Ontario Public Drug Programs, who makes all final funding decisions.
The Ontario Steering Committee for Cancer Drug Programs was created in 2013 to enhance and support the administration of Ontario's cancer drug programs. The committee advises the ministry's Ontario Public Drug Programs and our Provincial Drug Reimbursement Programs, on cancer-specific policy and processes.
Creation of the Steering Committee aligns with the objectives of Ontario's Action Plan for Health Care, which focuses on quality and consistent care, organized around patients and based on the best evidence.
Cancer Drug Evaluation in Ontario
The Committee to Evaluate Drugs–Cancer Care Ontario (CED–CCO) sub-committee was formed in September 2004, when the Ministry of Health and Long-Term Care (ministry) and CCO implemented a shared process to ensure consistent and coordinated cancer drug funding recommendations. The subcommittee considered the clinical and cost effectiveness of cancer drugs, and made recommendations to the CED, where recommendations were considered from the perspective of the broader health system.
The sub-committee served as the interim Joint Oncology Drug Review (iJODR) starting in 2007, sharing recommendations with other participating ministries of health and provincial cancer agencies in Canada. The iJODR was permanently replaced with the pan-Canadian Oncology Drug Review (pCODR) in 2011, and the CED-CCO subcommittee was then dissolved. That left Ontario with a need for arms-length, cancer-specific policy and program advice to support cancer drug reimbursement programs and processes.
Pharmacoeconomics Research Unit
Regardless of the process used to evaluate new cancer drugs, decision makers and expert committees continue to face challenges when it comes to funding cancer drugs. Often, the clinical evidence required to make a confident decision regarding a drug’s true value is not yet established. If clinical data are not strong, there is a large degree of uncertainty about cost effectiveness. In an effort to address the evidence gaps in drug policy decision making, CCO established a
Pharmacoeconomics Research Unit
to conduct in-house pharmacoeconomic analyses.