Funding for uncovered cancer drugs is available but can be difficult to access, advocate says

Watch the video above: Special cancer funding program can be difficult to access, advocate says 

TORONTO – After two separate cases of Ontario residents fighting for unapproved cancer drugs, Global News has learned that Cancer Care Ontario does in fact provide funding for drugs not currently covered by OHIP.

Cancer Care Ontario has three programs through which they provide funding for drugs. The first and largest of the three is the ‘new drug funding program.’ That program provides funding for drugs already approved by the provinces.

The second program is the Evidence Building Program. In this program, Cancer Care Ontario will provide funding for drugs which the agency believes could be funded in the future, but which haven’t been the subject of a clinical trial.

“The best option is just to fund the drug, collect data on whether it works and then make a formal funding decision down the road,” said Scott Gavura, director of provincial drug reimbursement programs for Cancer Care Ontario.

The third program is the Case-by-Case Review Program (CBCRP).  It reviews cases of patients with “urgent and rare clinical circumstances” who may require treatment that is not already covered by OHIP.

The CBCRP also considers funding uncovered drugs for cancers that are “immediately life-threatening.”

The New Drug Funding program provided $250 million in treatment in 2013.

The other two programs funded far less in treatment at $250,000 in 2013.

Watch the video above: Crystal Goomansingh gives some tips on how to access the funding.

“The criteria for a patient to meet the requirements of getting the drug are very stringent and in my experience patients will go that route, or the physician will go that route on behalf of the patient and they’re not getting the drug,” said Sue Robson, director of advocacy and stakeholder relations with Lymphoma Canada.

Global News previously reported on two different Ontario residents, Kimm Fletcher and Frank Italiano, who were fighting for cancer drugs not covered by OHIP.

Italiano has B Cell Lymphoma. He wants to access a drug called Adcetris.  It is covered by OHIP to treat some cancers, but not the type he has. He can get the drug privately but each treatment costs $15,000.

Fletcher has been battling brain cancer since 2010. She briefly went into remission but then the cancer came back.  She was diagnosed with stage three, then stage four brain cancer in Sept. 2013. She wanted to use a drug called Avastin in the hopes it would extend her life.  The government would not cover the drug so family and friends fundraised to purchase the drug.

“I can tell you it’s improved with just one treatment, from being bed-bound to being able to walk my daughter to and from school the next day,” she said after a meeting with Health Minister Deb Mathews on Oct. 30.

Fletcher accesses Avastin privately at a clinic in Burlington. But Avastin, like Adcetris, is expensive; $4,300 per treatment.

Cancer Care Ontario doesn’t directly approve funding. Instead, the agency’s programs review cases, gather evidence and make a recommendation for or against funding to the Ministry of Health’s executive officer of Ontario public drug programs.

Robson, however, is baffled that Ontario doesn’t have a program where, in special cases, patients’ physician can determine exactly what drugs they need.

“I can’t believe that we can’t come up with some sort of a system that can be in place that the physicians are the ones making the decisions whether a patient meets the criteria or not and that these patients can be helped,” she said.

Gavura said the case-by-case review program is meant for those drugs where there is no foreseeable funding.

“The program was really established in order to provide funding for circumstances where we know that no permanent funding decision, or formal funding decision will emerge down the road,” he said.