Why are some injectable cancer drugs unfunded (not paid for by the public health system)?
Cancer drugs that are unfunded are approved for sale in Canada but have not been approved for public funding. This means that people can buy the drugs with their own resources (money, private insurance etc.).
- There are many reasons why a drug may be unfunded:
- The drug does not meet the standards for medical value and cost.
- There may not be enough clinical proof for drug value.
- The drug may not offer enough value over treatments that are approved.
- The data for the use of the drug may be new and still under review.
- The drug may be used for a rare health problem or disease and there may not be enough proof of its value to get public funding.
In Ontario, Cancer Care Ontario (CCO) decides what drugs will be publicly funded.
If drugs are unfunded, why are they offered at the Princess Margaret?
Princess Margaret offers drugs that are unfunded because:
- Some oncologists (cancer doctors) believe the drug may help some patients.
- Some patients want to get these drugs at Princess Margaret, under the care of their oncologist instead of getting them in a private clinic.
How do I know if an injectable cancer drug that is unfunded is right for me or my loved one?
Talk with your oncologist (cancer doctor) to learn more about whether an unfunded drug is an option for you or your loved one. Only a small number of people with cancer might benefit from these drugs. If you pay for the drug at Princess Margaret, the drug will only be ordered for you by your oncologist (cancer doctor).
Who can get cancer drugs that are unfunded?
Any patient with a prescription for the drug is able to get the drug. But, the patient (or family, friend, insurance) must be able to pay the cost of the drug and an administrative and treatment fee to the hospital. Some patients may have private health insurance that will cover some or all of the costs.
Who can I talk to about options for payment?
There are many options for payment, these include cash, insurance and third party assistance programs. At the Princess Margaret, a person called a Medication Reimbursement Specialist can help you:
- Understand your options
- Know what coverage you have
- Know what other coverage you may be able to get
Call and book an appointment to speak to the Medication Reimbursement Specialist at: 416 946 2830.
More details:
The Finance department at Princess Margaret will accept your payment and ask you to sign an agreement to terms of treatment.
Full payment for each treatment cycle is needed before your treatment is scheduled. If you and your doctor decide to stop treatment with the unfunded drug because it is not helping you, you will be refunded the cost of the drug that you did not get.
