Public Drug Funding and Administration in Canada
There are effectively 3 steps required before a cancer drug becomes a publicly-funded benefit in Canada:
- Health Canada provides federal market authorization to sell a drug.
- The clinical- and cost-effectiveness of a drug is evaluated through the pan-Canadian Oncology Drug Review. This process considers information and perspectives from manufacturers, oncologists, economists and patients.
- Each province or territory then makes its own funding decisions, where the issue of affordability must be considered.
Prescription drug costs are a significant challenge to the sustainability of Canadian health insurance programs. Each Canadian province has its own programs to guide decision-making on new and often very costly therapies.
In a public system, we have a dual responsibility – delivering high-quality care to patients and spending healthcare dollars wisely to produce the greatest value for patients and society.
Drug Funding and Decision-Making in Ontario
Ontario has a rigorous process for evaluating drugs. It includes an explicit consideration of a drug’s safety, as well as the clinical- and cost- effectiveness of each drug. This process also incorporates input from patients on quality of life considerations.
The pan-Canadian Oncology Drug Review (pCODR) was established in 2011. Both the Ministry of Health and Long-Term Care (MOHLTC) and Cancer Care Ontario are partners in the pCODR process, along with other ministries of health and cancer agencies.
In April 2014, pCODR was transferred to the Canadian Agency for Drugs and Technologies in Health (CADTH). CADTH is the home of the Common Drug Review (CDR), which reviews non-cancer drugs:
- Pharmaceutical manufacturers and provincial disease site groups initiate new cancer drug funding requests via the pCODR process.
- pCODR recommendations flow to the Committee to Evaluate Drugs (CED) and then to the Executive Officer (EO) of Ontario Public Drug Programs who makes all final funding decisions.
The Ontario Steering Committee for Cancer Drugs was created in 2013 to enhance and support the administration of Ontario's cancer drug programs. The committee advises the ministry's Ontario Public Drug Programs and our Provincial Drug Reimbursement Programs, on cancer-specific policy and processes.
The creation of the Steering Committee aligns with the objectives of Ontario's Action Plan for Health Care, which focuses on quality and consistent care, organized around patients and based on the best evidence.
Pharmacoeconomics Research Unit
In an effort to address the evidence gaps in drug policy decision-making, we established a Pharmacoeconomics Research Unit to conduct pharmacoeconomic analyses. Often, the clinical evidence required to make a confident decision about a drug’s true value is not yet established. If clinical data are not strong, cost-effectiveness analysis can help by characterizing what is uncertain and how this will affect the funding decision.