Just because a new therapy has been shown to be effective in a clinical trial doesn’t mean that it is automatically available in Canadian hospitals, clinics or pharmacies. Before a drug can be used in Canada, it must go through a rigorous approval process at Health Canada. Health Canada does not look solely at whether a new agent is safe, but at the balance between risks and benefits.
If the drug company’s submission is approved, Health Canada will issue a Notice of Compliance (NOC) and give the drug a Drug Identification Number (DIN). This means the company is now allowed to market the new drug in Canada. In some cases, Health Canada may award a Notice of Compliance with Conditions (NOC/C). A drug awarded with a NOC/C is given a DIN but the sponsoring company must agree to special conditions or requirements, such as for more research or professional and patient education.
Once a new agent is approved for use in Canada, the manufacturer must make a submission to the national Common Drug Review (CDR) committee. The Common Drug Review was set up by the federal government to make recommendations as to whether new drugs should be covered under provincial formularies – the list of medications they will pay for. The hope was that it would streamline the drug review process and help to encourage greater consistency across the country.
In reality, most provincial drug plans continue to make their own decisions as to which medications they will or will not list. As a result, the coverage of new agents often varies across the country. In some cases, even when a new agent is added to a formulary, the decision as to whether to pay for it is made on a case-by-case basis. This special authorization process requires your physician to write a letter to the drug plan, explaining why you require this particular medication.
There are basically four ways of paying for cancer drugs:
It may take some research to ensure you have optimal access to new prescription medications – and to minimize your own out-of-pocket costs. Here are some tips to help you.
For more information, check out www.DrugCoverage.ca, a free resource providing information about prescription drug reimbursement in Canada. There is also additional information on this site on how to be your own advocate when you need new or emerging therapies.
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