Cancer Care Ontario (an independent government agency and chief advisor on cancer care to the Minister of Health) and the province released a proposal recommending that hospitals be allowed to charge patients for certain cancer care drugs not covered by the province.
Essentially the proposal would allow Ontario hospitals to sell and administer, on a patient-pay basis, cancer drugs approved for sale in Canada but unfunded by the Ontario government. If the proposal were adopted, patients would pay for the unfunded drugs and a user fee for hospital services. if the proposal is adopted, unfunded cancer drugs billed to patients covered under a Group Insurance Program or Extended health Care Plan will be eligible for payment in most circumstances.
For now, from an administrative standpoint, all carriers will continue to adjudicate claims as they have in the past (i.e. will not cover cancer drugs administered in a hospital). As further background information, under the Canada health Act, drugs administered at a hospital are intended to be covered under the hospital budget. Cancer care Ontario's proposal, if adopted, may affect access to and coverage for these "hospital drugs".
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