Several different payment sources exist for cancer drugs, depending on the medication, and how and where it is delivered.
Public Funding Options for Cancer Drugs in Ontario
These tables summarize the available public programs that fund the outpatient cost of cancer drugs.
Injectable drugs delivered in outpatient clinics in hospitals and cancer centres
Oral (“Take-Home Cancer Drugs”) and injectable drugs delivered through hospital or cancer centre outpatient pharmacies and community pharmacies
PROGRAM NAME |
PROGRAM STATUS |
WHO IS ELIGIBLE |
Ontario Drug Benefit2 |
Standard |
Ontarians who are eligible for benefits under the Ontario Drug Benefit Program3 |
Exceptional Access Program (EAP)2 |
Special authorization required |
Ontarians who are eligible for benefits under the Ontario Drug Benefit Program3 |
Case-by-Case Review Program (CBCRP)2 |
Special authorization required |
Ontarians who are eligible for benefits under the Ontario Drug Benefit Program3 |
This is a summary only. For details on patient and drug eligibility criteria and funded drugs, please refer to each drug coverage programs’ policies.
1 No cost to patients for eligible hospital- and cancer centre-administered injectable treatments
2 Copayments and deductibles may apply
3 ODB eligible recipients include Ontarians who are aged 65+; those living in long-term care homes or homes for special care; enroled in the Home Care program; Ontario Works; Ontario Disability Support Program; and those registered in the Trillium Drug Program (TDP)
Note: For eligibility criteria, refer to each drug program's policy.
Cancer Drugs Provided in Hospitals and Cancer Centres
Some cancer drugs are covered by the hospital directly, as part of its global budget. Others may be covered by a certain funding program:
- Our New Drug Funding Program (NDFP) directly covers the cost of many newer and often very expensive injectable cancer drugs.
- Our Evidence Building Program covers the cost of cancer drugs in situations where data is collected to answer an evidence gap, to evaluate clinical benefit and to confirm overall value.
- Our Case-By-Case Review Program considers requests for cancer drugs otherwise not funded, for patients with rare clinical circumstances that are immediately life-threatening.
In some situations, patients may use private insurance or pay directly for drugs that are not publicly funded. Some new and expensive injectable drugs not funded through the NDFP are available for private payment (either third-party insurance or self-pay), either out of province or at a private clinic. Some patients have these drugs administered at Ontario hospitals under the care of their own oncologists for private payment. Each hospital decides whether to administer unfunded injectable cancer drugs. The NDFP does not fund injectable cancer drugs administered in private clinics. Here are a few additional resources for information:
Cancer Drugs Taken at Home
Many Ontarians rely on private insurance for funding cancer drugs taken at home. However, several programs may provide cancer drug funding depending on the circumstances:
- The Ontario Drug Benefit (ODB) Program covers the cost of many drugs for seniors, those on social assistance and some other groups.
- Ontario residents with high drug costs in relation to their household income, who do not qualify under other programs, can apply for the Trillium Drug Program.
- In very special cases, the Exceptional Access Program may provide patient-specific funding to ODB-eligible recipients where drugs on the ODB list have been tried and do not work, or specific criteria have been met.
- Our Case-By-Case Review Program considers requests for cancer drugs otherwise not funded, for patients with rare clinical circumstances that are immediately life-threatening.