Access to Standard Treatment for Malignant Brain Tumours is NOT Universal in Canada

Map of Canada

Find out whether Temozolomide is funded by clicking on your province.

The internationally accepted, standard treatment regimen for the most common type of brain cancer is not fully accessible in parts of Canada. This contradicts the approach of most other developed countries that have universal health care systems.

 
Currently, in Canada, Temozolomide is funded in one of three ways:

  1. The province takes responsibility for funding (100%)
  2. Technically it's the responsibility of the patient to pay, but the province or hospital offers alternative funding
  3. It is considered a prescription and is a patient's responsibility to pay.

Download an Infographic (PDF).

Download our Press Release (PDF) dated March 7, 2019.

On March 6, 2019, the Government of Canada released the Interim report from the Advisory Council on the Implementation of National Pharmacare - read this report.

Download our position statement on 'Access to Standard Treatment for Malignant Brain Tumours is not Universal in Canada' (PDF) or keep reading...

The internationally accepted, standard treatment regimen for the most common type of brain cancer is not fully accessible in parts of Canada. This contradicts the approach of most other developed countries that have universal health care systems.

More than 12 years ago, Health Canada and the provinces approved a three-part treatment as the standard of care for 1st line treatment of glioblastoma multiforme – the most common and aggressive form of brain cancer. The treatment involves surgery followed by combined radiation + chemotherapy. Since surgery and radiation are considered insured services given in a hospital setting, each province restricts universal funding to these two services only. To this day, the province continues to classify the chemotherapy portion – a drug called temozolomide – as a “prescription”. This is because temozolomide is produced primarily in pill form and is taken outside of hospital. The classification as a “prescription” makes the coordination and payment of temozolomide the responsibility of the patient and leaves 1/3 of this combined treatment as “uninsured”. The interpretation then is this is optional – when it is not. The treatment must be delivered together. Leaving the chemotherapy portion of this treatment uninsured risks failure of the entire treatment plan. For many brain cancer patients, this is their only treatment option.

Temozolomide is produced in both brand and generic form and has been long approved for funding on provincial formularies. The issue is not its funding, but in HOW that funding is accessed. Several provinces have taken steps to ensure residents with brain cancer have universal access to temozolomide (100%), but their approaches to obtaining that funding vary widely. There are several provinces, including Ontario, that continue to leave it as a “prescription” drug. In these provinces, patients rely on the skills and ingenuity of various health professionals to figure out “stop gap” solutions and navigate potential delays from paperwork, drug plan applications, etc. This fragmented and uncoordinated approach does little to ensure consistent delivery of care, adherence to treatment standards or the collection of reliable treatment data. It also does little to safeguard treatment continuity if a patient changes residence from one province to another.

To minimize harm and promote the efficient use of health resources, Canada needs to follow the example of other developed nations in ensuring temozlomide and other essential “take at home” cancer treatments are universally accessible to patients in every province.

Mapping the Issue

Brain Tumour Foundation of Canada has produced an illustrated “road map” of temozolomide access across Canada. The purpose is to demonstrate how a standard, first line cancer treatment for one cancer population is accessed differently in each province and territory. The map rates each province based on level of difficulty (red, yellow, and green indicators). The rating system is based on ease of access, necessity of health care provider involvement, and burden of cost or coordination on the patient.

The hope is that this roadmap may serve as a resource to those shaping a national system of pharmacare to demonstrate why a consistent, standardized and monitored method of drug access is essential to maintaining standard of care for cancer in Canada. 

Alberta

Traffic Light Green

 Temozolomide is funded 100% for all clinical indications for any resident with an Alberta Health card who is followed by an oncologist at one of the Alberta Cancer treatment locations throughout the province. The chemotherapy order is written by the oncologist and is filled at the hospital pharmacy at the time of your visit. If you are unable to make it to the hospital pharmacy for a scheduled pick-up, the pharmacy will courier the medication to you. There is no cost to you.

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< Back to Equal Access to Care
 

British Columbia

Traffic Light Green

Temozolomide is funded 100% by BC Cancer for residents with a valid provincial health card when the drug is prescribed by a qualified oncologist and the person is receiving the treatment at a BC Cancer centre. It is covered for a broad range of indications for up to 12 cycles of treatment. This is confirmed by your oncologist at the time of the chemotherapy order is written. You pick up the drug at the hospital pharmacy at your local cancer centre. There is no cost to you.

< Back to the map

< Back to Equal Access to Care

 

Manitoba 

Traffic Light Yellow

Temozolomide is funded 100% for residents with a valid provincial health card who don’t have coverage through a federal public plan or other provincial pharmacare plan. A person must enroll in the “Manitoba Home Cancer Drug Plan” to qualify. A staff person at the cancer centre will help with this enrollment process. Once enrolled, the drug is covered for all clinical indications at 100%. The oncologist writes the prescription and you fill the prescription at any retail pharmacy. The pharmacy bills the cost of the drug directly to Manitoba Pharmacare. There is no cost to you.

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New Brunswick

Traffic Light Red

Temozolomide is your responsibility to pay for in the province of NB. A social worker or a drug access navigator will help you apply for assistance with the cost of the drug. If you’re co-pay remains too high through your personal insurance plan or if you lack an insurance plan that person will direct you to apply to the Department of Social Development. A financial needs assessment will be completed over the phone to determine your eligibility. If you are found to be eligible Temozolomide will be covered at 100%. If you do not qualify through the Department of Social Development, then the social worker will help you apply for the NB Drug Plan. Temozolomide is covered for all clinical indications on the provincial Drug Plan formularies. The final cost to you will dependent on your insurance plan or how much assistance you qualify for under the NB government plans. The oncologist will provide the prescription and you fill it at any retail pharmacy.

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Newfoundland and Labrador

Traffic Light Yellow

Temozolomide is considered your responsibility to pay for in Newfoundland-Labrador, but the main cancer centre in St John’s takes steps to ensure you do not have to pay out of pocket on this drug. If you have an insurance drug plan or a federal public drug plan, the pharmacist will bill this plan and help you through any paperwork that is required to get the drug covered. If there are leftover costs, if you lack a plan, or if you normally rely on the provincial prescription drug plan, then the pharmacist will be the cost directly to the hospital. There is no cost to you.

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Nova Scotia

Traffic Light Yellow

Temozolomide is your responsibility to pay for in the province of NS; however, there is coverage available at 100% under the NS Pharmacare program. You can choose to apply for cost assistance through your insurance plan, at whatever amount of coverage that plan provides, or you can apply to the NS Pharmacare program for 100% coverage. If you choose this latter option, you will need to provide your family income information and SIN. The social worker or drug access navigator will help you navigate this process. Once qualified, the NS Pharmacare program provides coverage for high grade brain tumours for up to 12 cycles. The oncologist will provide a prescription that you fill at any retail pharmacy. If you have opted for the NS Pharmacare coverage, you will need to inform the pharmacy of this coverage.

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Northwest Territories

Traffic Light Red

In the different territories, those with insufficient private insurance and who are not registered First Nations/Inuit and on the NIHB federal drug plan are offered an extended health benefit plan. A health professional will help you apply if this is needed. Coverage is 100% once in place but is restricted to only higher grade brain cancers for a period of 12 months. The pharmacist or prescriber must apply directly to each drug plan to get coverage approved. The drug may be filled at a retail pharmacy, a hospital pharmacy, or a clinic depending on where you are being treated.

< Back to the map

< Back to Equal Access to Care

 

Nunavut

Traffic Light Red

In the different territories, those with insufficient private insurance and who are not registered First Nations/Inuit and on the NIHB federal drug plan are offered an extended health benefit plan. A health professional will help you apply if this is needed. Coverage is 100% once in place but is restricted to only higher grade brain cancers for a period of 12 months. The pharmacist or prescriber must apply directly to each drug plan to get coverage approved. The drug may be filled at a retail pharmacy, a hospital pharmacy, or a clinic depending on where you are being treated.

< Back to the map

< Back to Equal Access to Care

 

Ontario

Traffic Light Red

Temozolomide is your responsibility to pay for in the province of Ontario. Your health team or a drug access navigator at the cancer centre will help you apply for assistance with the cost through your insurance plan or one of the plans through the Ontario Drug Benefit (ODB). Cost coverage may not be 100%. This will depend on your plan. The health team member or drug access navigator will help you navigate additional cost assistance or a temporary supply of the drug while you get things worked out. The person will also need to check with your plan to see what clinical indications will be covered and for how long. Most ODB plans restrict coverage to high-grade brain cancers for a specific duration. Once the prescription is written by your oncologist, you fill the drug at any retail pharmacy.

< Back to the map

< Back to Equal Access to Care 

Prince Edward Island

Traffic Light Red

Temozolomide is your responsibility to pay for in Prince Edward Island. A social worker, navigator or your oncologist will help guide you through the process of applying for cost assistance through your insurance plan. If you lack and insurance plan, that person will then help you to enroll in a PEI Pharmacare program if you do not have one already. Temozolomide is covered for most clinical indications in several PEI Pharmacare programs. Once coverage is in place, the oncologist will write the prescription and you fill it at any retail pharmacy. The final cost to you will depend on your drug plan.

< Back to the map

< Back to Equal Access to Care 

Quebec

Traffic Light Red

Temozolomide is covered by both insurance plans and the public drug plan (RAMQ) in Québec (you must be a resident of Québec and enrolled in the RAMQ to qualify for coverage through that program). The criteria for coverage is restricted to those with a higher grade brain cancer. Your oncologist writes the prescription and you fill it at a retail pharmacy. The pharmacist will help to coordinate any paperwork required by your insurer or the RAMQ. Any cost to you is dependent on your insurance or RAMQ plan.

< Back to the map

< Back to Equal Access to Care

Saskatchewan

Traffic Light Green 

Temozolomide is funded 100% by for residents with a valid provincial health card when the drug is prescribed by a qualified oncologist. It is covered for a broad range of indications, for up to 12 cycles of treatment for new patients or ongoing for recurrent patients. This is confirmed by your oncologist at the time of the chemotherapy order is written. You pick up the drug at the hospital pharmacy at your local cancer centre. There is no cost to you.

< Back to the map

< Back to Equal Access to Care

Yukon Territory

Traffic Light Red

In the different territories, those with insufficient private insurance and who are not registered First Nations/Inuit and on the NIHB federal drug plan are offered an extended health benefit plan. A health professional will help you apply if this is needed. Coverage is 100% once in place but is restricted to only higher grade brain cancers for a period of 12 months. The pharmacist or prescriber must apply directly to each drug plan to get coverage approved. The drug may be filled at a retail pharmacy, a hospital pharmacy, or a clinic depending on where you are being treated.

< Back to the map

< Back to Equal Access to Care 

 

 

 

 

Yukon Territory British Columbia Northwest Territories Nunavut Alberta Saskatchewan Manitoba Ontario Quebec Newfoundland and Labrador New Brunswick Nova Scotia Prince Edward Island
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