Public Reimbursement Policies for Oncology Medicines in Canada

Abstract

What Is the Issue? Oncology medications can be broadly classified into treatments that are administered in a hospital and treatments that can be taken in the home setting. In Canada, public drug plan reimbursement for oncology medication varies between federal, provincial, and territorial (FPT) jurisdictions, and depending on the setting of administration. What Did We Do? We conducted a literature search of key resources, including the websites of health care agencies in Canada and FPT public drug programs as well as a focused internet search. This information was validated and supplemented with details gathered from surveying FPT public drug plans. What Did We Find? Most public drug programs provide coverage for hospital-administered oncology medications listed on their formulary, with no cost to patients. Between jurisdictions, there is variability in terms of public reimbursement of take-home oncology medications: Some jurisdictions provide full coverage for take-home oncology medications if the medication is listed on their formulary and the patient meets prespecified clinical criteria, while other jurisdictions limit coverage to patients eligible for a specific drug plan. In some cases, patients may receive varying levels of reimbursement depending on the drug plan they are enrolled in, and some may incur additional out-of-pocket costs. Nearly all jurisdictions provide alternative pathways for the reimbursement of oncology medications not listed on their formulary. Key differences between jurisdictions include how supportive medications are defined, the availability of programs covering high-cost treatments, and if and how CAR T-cell therapy is reimbursed. What Does It Mean? While most jurisdictions provide access to oncology medications delivered in hospital settings at no cost to patients, coverage for take-home medications is often dependent on specific eligibility criteria, income thresholds, patient age, and the availability of private insurance. There may be opportunities for future alignment of oncology medication funding policies across public drug plans in Canada, including alignment of definitions for hospital-administered, take-home, and supportive care