Variation and consternation: access to unfunded cancer drugs in Canada

Abstract

Purpose: New anticancer drugs are improving outcomes for patients with cancer but at significant cost, and some publically funded health care systems have chosen not to fund these medications. Accessing these unfunded drugs concerns patients, challenges their physicians, and raises important policy and legal issues. We assessed Canadian medical oncologists' access to and attitudes toward accessing unfunded intravenous cancer drugs.

Methods: Two hundred twenty-two Canadian medical oncologists outside of Québec were surveyed.

Results: Response rate was 62% (138 of 222). Respondents could access unfunded cancer drugs (49% at their government-funded hospitals; 70% at nongovernment-funded private infusion clinics), but access varied across the country. A majority of respondents (52% to 67%) were comfortable with accessing unfunded drugs in their own institutions and uncomfortable with accessing these drugs in private clinics in Canada or the United States (52% to 61%), but substantial minorities had opposing opinions. The majority of respondents felt all methods of accessing unfunded intravenous cancer drugs should be available (76% in their own center; 60% in private clinics) and used these methods to access these medications (81% in their own institution; 62% in private clinics).

Conclusion: Access to effective but unfunded cancer drugs varies across Canada. Policymakers need to consider whether this is consistent with articulated values of the system and whether currently planned processes address these inconsistencies. Key stakeholders need to consider the merits of the different means of accessing these drugs to appropriately and fairly integrate access into publically funded health care systems like that of Canada and other systems like that of the United States, which could face similar limits in the future.

Figure 1.

(A) Access to unfunded drugs in Canada at respondent's institution. (B) Access to unfunded drugs in private clinics. Results are for access via private insurance. Access via out-of-pocket payment was essentially the same (Data Supplement). AB, Alberta; BC, British Columbia; MB, Manitoba; NB, New Brunswick; NL, Newfoundland; NS, Nova Scotia; ON, Ontario; PE, Prince Edward Island.