Ontario has narrowed the circumstances in which it will pay for cancer drug treatments outside Canada, weeks after a court ordered the province to reconsider its rejection of coverage for a man with advanced melanoma. The amended rules say out-of-country drug funding is available only when the treatment is already publicly funded in Ontario but temporarily unavailable or delayed, and the delay threatens death or medically significant irreversible tissue damage.
Alex Shved, 37, sought tumour-infiltrating lymphocyte therapy in Florida after Ontario’s health plan rejected his oncologist’s application twice. A Divisional Court ruling in September found the denial’s reasoning lacked a real basis and ordered a new decision. OHIP rejected the request again, while the government said it was exploring a possible resolution in his individual case. The treatment, which involves multiplying a patient’s tumour-fighting immune cells before reinfusing them, costs about US$600,000 and is under review for possible provincial funding.
The government says the regulatory change reflects policy in place since 2011 and protects Ontario’s negotiating position with drug manufacturers. The rules also require drugs and their administration to be publicly funded in Ontario before temporary access problems can qualify for overseas coverage.
Patients say the change closes the route they hoped the court case had opened. Sabrina Apitz-Grossman, 31, has metastatic synovial sarcoma and was given an estimated 12 to 18 months to live. Her doctors recommended Tecelra, a U.S. -approved therapy unavailable in Ontario, but both her out-of-country application and a case-by-case request to receive it in Toronto were denied; she says the treatment would cost about US$727,000.
Holly Wardlow, 61, is paying about $78,000 a month for infusions for a rare liver cancer after Ontario rejected coverage for a drug whose manufacturer told the province it had no plans to seek Canadian approval. Wardlow says her tumour has shrunk with few side-effects, but her savings are depleted and her family has begun fundraising.