How Cancer Treatments are Funded
There are variations in how the provinces and territories fund cancer treatments.
The western provinces (BC, AB, SK, MB) each have a system of funding cancer drug treatments at 100%. There is no cost to the patient. This funding applies to intravenous drug treatments administered within a hospital chemo unit, AND drug treatments that are taken at home (e.g. pills). It doesn’t matter how the drug is taken. But, to be funded the drug treatment must be on the provincial formulary. This means the drug treatment has been reviewed and approved for funding by the province. Each drug treatment introduced in Canada goes through a lengthy process of review before it is listed on a formulary. It is up to each province or territory to decide if they fund a drug treatment.
In all other provinces and territories in Canada (ON, QC, NS, NB, PE, NL, NT, NU, YK), only cancer drug treatments that are administered in a hospital setting (e.g. chemotherapy unit) are covered fully. Cancer drug treatments taken at home are considered the responsibility of the patient. That patient is expected to use their own health benefits plan to cover the cost. If a person does not have enough coverage, each province and territory offer publicly subsidized drug plan options that helps with some of the cost. The drug treatment must be on the formulary for that provincial/territorial drug plan. Access to these provincial/territorial drug plans is not automatic – you must apply.
It can be difficult to find out if certain drug treatments are covered by a province or territory, because most provinces do not list the information on public websites. You must rely on the information you receive from your oncologist. Some insurance plans and drug plans do list information on their websites about which drug treatments they cover, but it is best to contact these plans directly to confirm if the information applies to your plan.
In most cancer centres there is someone that can help you navigate your coverage options. There may also be a patient support program for your drug treatment that offers this service. You can also check the information on MedSearch.
Federal Programs for Specific Populations
Some people in Canada are covered under separate federal programs because the federal government has mandated responsibility to provide for their health and wellness:
First Nations and Inuit - persons registered in the Non-Insured Health Benefits (NIHB) program have coverage for certain prescription drugs, drug treatments, mental health care, eye care, dental benefits, and various medical supplies. Inquiries about drug coverage are usually initiated from the pharmacist directly to NIHB, but those registered with the program can also call NIHB directly or visit the NIHB website.
In the province of BC, First Nations members who may not receive NIHBNon-Insured Health Benefits Program for First Nations and Inuit Peoples coverage are eligible for coverage under BC Pharmacare First Nations Health Benefits (Plan W).
Veterans – persons who are registered with Veterans Affairs and receive (a) disability benefits, (b) War Veterans allowance, or are eligible for the (c) Veterans Independence Program (VIP) or (d) Veterans Long Term Care may also be eligible for drug coverage; the extent of coverage varies by level of service or eligibility; some drugs are covered automatically at a pharmacy while others need Special Authorization; requests are initiated by a pharmacist; to review the list of approved drugs on the Veterans Affairs formulary, go to their website.
If the drug is not on the list, it may still be considered. In this type of case the prescriber contacts the Veterans Affairs Special Authorization Unit directly at 1-888-VAC-AUTH.
Retired Military and Federal Civil Servants – Those who have served in the military but are no longer in active roles or who are retired have the option of enrolling in the Public Service Health Care Plan; this plan is also available to active civil servants and support staff of the RCMP; this plan is a group insurance health benefits plan that provides 80% of many different prescription drug therapies; persons who are on this plan pay 20% of the prescription cost at each fill but only to a maximum of $3,000 out of pocket per year; information on what is covered can be found here.
Active Military and RCMP – If you are on active duty with the military or Royal Canadian Mounted Police (RCMP) then you have your drug treatments dispensed on site or as directed by your workplace; coverage is comprehensive and is managed by the military and RCMP pharmacies
Inmates in Federal Institutions and those newly released– the Correctional Services of Canada (CSC) is responsible for maintaining the health and well being of inmates; drug and benefit coverage is managed by CSC pharmacies, located on-site in federal institutions; the on-site pharmacists initiate Special Authorization requests for cancer drug treatments through the CSC; once paroled, a person must transition back to a provincial health card which can take up to 3 months; once the card is initiated, that person accesses drug benefits similar to any other provincial or territorial resident; usually if a person is paroled or discharged from a federal institution and is on a cancer drug treatment, a plan is made to provide a person with that treatment while they are transitioning back to the provincial health card
Refugees or Federal Detainees – the federal government provides limited, temporary health benefits through the Interim Federal Health (IFH) program for (a) re-settled refugees who have come to Canada through government or private sponsorship; (b) persons who are waiting on a refugee or asylum claim; (c) persons who have been granted asylum or protection in Canada, (d) detainees, and (e) victims of human trafficking who have a temporary residency permit while their case is being prosecuted. When the person is eligible for provincial health services they are transitioned to the appropriate funding. Those on the IFH have a drug card and coverage is administered through the card by the pharmacy. Any requests for Special Authorization are initiated through a pharmacy.