Ontario narrows out-of-country drug funding rules after cancer patient court victory

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. His cancer has spread to his lungs and his bones and he tried every avenue he could think of to ensure he is around for his daughters as long as possible.He was successful in court but is now “incredibly disappointed and disheartened” to see the government further closing the door for patients in his situation.“The courts concluded that the government’s actions were unlawful, and the government’s response was to change the law to make those same actions now lawful,” Shved said in an interview. OHIP had 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.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.Following that ruling, OHIP 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.“We’re protecting Ontario patients and taxpayers from price-gouging and protecting their access to life-saving medications that would otherwise only be available in the United States or overseas,” she wrote in a statement.The government is also exploring a “mutually satisfactory resolution” in Shved’s individual case, Jones wrote, but Shved said he is so far unclear on what that would entail.Shved has tried various treatments since first discovering a growing mole in 2020 and his doctors say he would be a good candidate for TIL therapy. It involves doctors removing tumours, extracting immune cells that have infiltrated the tumours, multiplying them in the billions and infusing chemotherapy, then injecting the multiplied cells back into the patient to attack the cancer.A version of TIL therapy called lifileucel was approved for sale last year by Health Canada, and is now undergoing reviews for consideration of possible funding by provincial drug plans, a process that could take years.

Ontario narrows out-of-country drug funding rules after cancer patient court victory

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