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Hi everyone,

Access to new intravenous cancer drugs within our publicly funded health care system is a complicated and sometimes emotional debate. Everyone has heard of a patient who wants access to a drug that's not funded by the province. These unfunded drugs are never curative therapy- all potentially curative drugs are funded by the Ministry. However, the patient certainly may achieve some benefit from unfunded medications.

In Ontario, there is a good process to evaluate new cancer drugs for provincial funding. A Committee organized by Cancer Care Ontario (CCO) is made up of physicians, economists, pharmacists and ethicists. This Committee has the difficult task of evaluating the clinical benefit of all new cancer drugs with cost being one component of the deliberation. This Committee then makes a recommendation to the Ministry of Health and Long-Term Care for or against funding.

Over the last few months, the province announced funding for new and expensive intravenous cancer drugs, including Velcade and Herceptin, on the advice of this group. However, some drugs are not approved for public funding, usually because they don't meet the test for cost-effectiveness. However, there are some patients who are willing to pay for these unfunded drugs. Up to this point, these patients had two choices: to receive treatment in a private clinic here in Toronto or to travel to an American Cancer Center for therapy.

In order to determine how these patients could be treated in Ontario Cancer Centers, the Ontario Hospital Association, the Council of Academic Hospitals for Ontario, CCO and the Ministry asked for recommendations about access to unfunded chemotherapy from a Working Group of experts that I helped to chair.

Today, this Working Group recommended a standard approach to increasing access to unfunded cancer drugs in Ontario hospitals. We believe that all Ontario patients who have decided to purchase unfunded drugs should have a better choice than traveling to the U.S. or to a private clinic in Toronto for access. The prime consideration is the provision of all medications by the care team responsible for the patient. Traveling away from home creates additional hardship for patients, and raises reasonable concerns about safety and continuity of care. Because cancer treatment in American centers is always more expensive that it would be in Ontario hospitals, more patients would have access to this unfunded therapy if it were provided in more cost-effective fashion closer to home.

Let me be clear that these recommendations do not affect in any way cancer drugs that are or will be covered by our publicly funded system. Patients will still have access to high quality cancer drugs through the New Drug Funding Program, Ontario Drug Benefits Plan, Trillium and hospital budgets as they do today. We will not start charging for drugs that currently are provided within our publicly funded envelope. However, the Working Group does recommend that patients who choose to access unfunded drugs should receive treatment in the most cost-effective, safest and most humane fashion possible.

At this point, these are only recommendations to the Ministry. In the meantime, our practices at UHN will remain the same. I'm sure there will be much discussion over the next few weeks as we await the Ministry's response to these recommendations and I will keep you in touch about this issue.

A full copy of the provincial working group report is available at:
www.cancercare.on.ca

Bob​

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