Ontario drug funding decision leaves cancer patients disappointed, with few options

Sabrina Apitz-Grossman was told 13 months ago that she had about 12 to 18 months to live. A rare form of cancer in the 31-year-old’s knee had metastasized, spreading to her lungs. She has undergone radiotherapy, chemotherapy and surgeries, though the synovial sarcoma couldn’t be fully removed.

Apitz-Grossman’s doctors are recommending a treatment approved in the United States but unavailable in Ontario. She needs it urgently but the Ontario Health Insurance Plan turned her down for out-of-country coverage. An appeal failed, as did an application under a Case-by-Case Review Program to get special permission for the treatment to be administered at the Princess Margaret Cancer Centre in Toronto.

“I so desperately would love to turn 32,” she said. Apitz-Grossman and other Ontarians with Stage 4 cancer told by their doctors that they are good candidates for treatments unavailable in the province were buoyed last month when 37-year-old Alex Shved, in a similar situation, won a court challenge against his OHIP out-of-country denial. But their hopes were dashed when Health Minister Sylvia Jones responded to the court ruling by changing the rules.

Drug treatments will now only be funded out of country if they are already funded within the province but access is temporarily unavailable or delayed, a set of circumstances some patients see as impossibly narrow. The government said it clarified in regulation what was already long-standing policy. “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,” Jones wrote in a statement.

“This change supports a consistent, fair and transparent approach to funding decisions, protects the integrity of Ontario’s world-class drug approval process and will help avoid up to $5.2 billion in additional costs to Ontario’s health-care system every year.” Framing the move as a cost-saving measure is not sitting right with Apitz-Grossman. “Are we saying that we could save like 5,000 or more people’s lives, and they’re proud of themselves for not doing that?” she said. “Is this supposed to be good news that we’re not going to save those people, so that we can instead buy a couple more private jets?” Ontario Premier Doug Ford came under fire earlier this year for a government purch…

TORONTO - Sabrina Apitz-Grossman was told 13 months ago that she had about 12 to 18 months to live.