Ontario narrows out-of-country drug funding rules after cancer patient court victory
Etobicoke father fighting bureaucratic battle to access cancer treatment
An Ontario man with Stage 4 melanoma says the province has effectively blocked access to public funding for out-of-country drug treatments in response to his attempts to urgently seek therapy in the United States.
Alex Shved, a 37-year-old father of two young children, took the province to court over Ontario Health Insurance Plan rejections.
OHIP denied his oncologist’s request for Shved to receive tumour-infiltrating lymphocyte therapy in Florida at an approximate cost of US$600,000, largely citing the fact that the therapy is under consideration for public funding in Ontario.
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The executive officer of Ontario public drug programs wrote in his denial that routinely funding out-of-country drug therapies while they are undergoing review in Ontario would “undermine the incentive structure that encourages manufacturers to participate in Canada’s drug review processes.”
A Divisional Court ruling found that OHIP offered no real basis for that reasoning and ordered OHIP to reconsider.
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Following that ruling, OHIP has now rejected Shved’s request for a third time and Health Minister Sylvia Jones announced that the province has amended regulations to clarify that drugs will only be funded out of country if they are already funded within the province but access is temporarily unavailable or delayed.
She also says the government is exploring a “mutually satisfactory resolution” in Shved’s individual case.
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