Care for many types of cancer changed from in-hospital to at-home over 10 years ago. Sadly, Ontario’s cancer treatment programs still haven’t caught up.
Take-home cancer treatments including oral medications and injections have become approved and essential therapies for an increasing number of patients. Sometimes these are the only forms of recommended treatment.
While patients who receive cancer treatment in hospital have equal access, patients who can be treated at home still face an outdated, patchwork system that leave them waiting to start and waiting for financial relief.
The Facts: In-Hospital vs At-Home Cancer Treatment in Ontario
When an intravenous cancer treatment is listed in Ontario, patients in need of that treatment face no financial questions, paperwork, or delays. No questions are asked about their household income, insurance coverage, or ability to personally pay co-pays or deductibles for the cancer medication. Patients can start their treatment as quickly as it’s needed – and often within 2 weeks.
In contrast, when take-home cancer treatments (such as pills and self-administered injections) are listed by the province, patients face a maze of prescription drug coverage programs. Patients under 65 years must navigate their own funding solution – using a combination of partial funding assistance options. This may include telephone calls, faxes, and letters to private insurance (if any), manufacturer assistance programs (if any), and Ontario’s Trillium Drug Program. Before they can take the first dose, they must navigate a complex system and even then, many will have to pay a significant amount from their personal funds.
Many Ontario families with private insurance often don’t have 100% coverage and face deductibles and co-pays of $2,000 per year and more. And increasingly, many plans have annual or lifetime caps, which are quickly met with the cost of cancer medications.
Find out how much take-home cancer treatment could cost your family in Ontario here.
What this Means for Cancer Patients in Ontario:
- Patients must wait for medically-necessary cancer treatments until they have all of the paperwork and funding sorted out. This is the patient’s responsibility to figure out at a time when most patients are least able to handle paperwork. Delays cause undue stress on top of their cancer diagnosis.
- Unlike intravenous medications, a prescription for cancer medication taken at home goes on hold until it can be dispensed at a local pharmacy. This can happen only once all of the details of funding have been finalized and the co-pays or quarterly deductibles have been paid at the cash register.
- Private insurance (personal or family coverage) must first be exhausted to the maximum coverage limits. This often means the family has no insurance room for other family members or other medications. Employer benefit programs rise in cost and small employers particularly feel the impact.
- Patients and their families must submit significant amounts of personal and financial information from household members’ income tax returns to qualify for assistance programs including the Trillium Drug Plan.
- Once the calculations are done, patients often face the dilemma of out-of-pocket expenses they simply cannot afford.
- Forty-four percent of Canadians only have $5,000 saved in an emergency fund, and 21% have less than $1,000. (BMO Study, 2015)
- High out-of-pocket expenses are known to impact whether a patient takes his or her treatment as prescribed.
- Deductibles and co-pays of over $50 per month are known to reduce patient adherence to medication.[i] For cancer medications, adherence is essential for cancer control.
- Beyond the impact on health outcomes, there are also economic consequences to patients, employers, and government such as disability, productivity, absenteeism and presenteeism.
- These complex programs and out-of-pocket costs create undue stress and anxiety for patients who are already shocked, stressed and scared from their cancer diagnosis, recurrence or disease progression. This is simply unfair.
What this means for health care providers:
- Clinicians are spending more and more of their time navigating drug access with the lengthy back-and-forth between the oncologist and the funding programs.
- Many initial requests made to the Exceptional Access Program (EAP) office are originally denied, only to be approved after a second submission by the clinician. In the meantime, the patient waits to find out which treatment for which they will need to seek funding.
What this means for Ontario’s Health System:
- Wherever intravenous, in-hospital treatments are available, access to these treatments is far easier to navigate and free of co-pays and deductibles. By penalizing patients who CAN take their treatments at home, Ontario’s drug programs encourage health care providers and patients to favour in-hospital treatments wherever available.