Funding & Reimbursement
Several payment sources exist for cancer drugs in Ontario, depending on the drug, disease indication, and how and where it is delivered. Cancer drugs may be covered by public funding programs, hospitals or by private pay through either insurance coverage or patient out-of-pocket costs.
The Ministry of Health and Long-Term Care is responsible for drug funding decisions, while Cancer Care Ontario oversees the reimbursement process based on those funding decisions.
Cancer Drug Funding Programs
Cancer Care Ontario administers 3 drug funding programs on behalf of the Ministry of Health and Long-Term Care. Through these programs we reimburse hospitals and regional cancer centres for injectable cancer drugs used according to established funding criteria.
All of our programs are managed by the Provincial Drug Reimbursement Programs (PDRP) Unit.
New Drug Funding Program (NDFP)
This program covers the cost of many newer, injectable cancer drugs administered in hospitals and cancer centres.
Evidence Building Program (EBP)
This program strengthens the New Drug Funding Program by resolving uncertainty around clinical and cost-effectiveness data.
Case-by-Case Review Program (CBCRP)
This program considers funding requests for cancer patients who have rare clinical circumstances that are immediately life-threatening.
Unfunded Intravenous (IV) Cancer Drugs
Review funding recommendations made by the Provincial Working Group on the Delivery of Oncology Medications for Private Payment in Ontario Hospitals.
Oncology Biosimilars Initiative
This initiative aims to ensure appropriate and cost-effective implementation and use of therapeutic oncology biosimilars across Canada. It is a joint initiative between the pan-Canadian Pharmaceutical Alliance and Cancer Care Ontario.
How the Funding Process Works
We review and process the hospital and regional cancer centre submissions for reimbursement of injectable cancer drugs. Hospitals and regional cancer centres must make sure that patients meet the eligibility criteria for each drug before starting treatment. Also, the drugs must be used according to the funding criteria. Hospitals are reimbursed based on established reimbursement cost per unit (e.g., per mg) for drugs administered to eligible patients.
Public Drug Funding & Administration in Canada
Learn how cancer drugs are evaluated in Ontario and the steps required for a drug to become publicly funded.
Ontario Steering Committee for Cancer Drugs
The Ontario Steering Committee for Cancer Drugs (OSCCD) was created in 2013 to enhance and support the administration of Ontario’s cancer drug programs.
Systemic Treatment – Quality-Based Procedure
Find out how funding is managed for the delivery of outpatient systemic treatment services based on evidence-informed practice.
Finding the Right Funding Program
If you are a patient looking for funding information, we encourage you to speak to your healthcare team for more information. Your doctor, pharmacist or hospital’s drug access navigator can help identify available funding options. Your prescribing doctors must complete and submit all enrolment forms and any supporting clinical documents (when required) before your treatment begins.