Melanoma, or any cancer for that matter, can be expensive to treat and manage. In a literature review conducted by the Canadian Cancer Society in 2010, findings found that most of the costs incurred by patients and their families were traced back to travelling expenses, out-of-pocket costs, and cancer drugs and prescription medicines.
The Canada Health Act says all Canadians ‘have access to the insured health services including all medically necessary hospital services, inpatient pharmaceuticals (medicines used while you are hospitalized), and medically required physician services .’ This means that medicines not used in-hospital (outpatients) are not always paid for, such as medicines that are taken orally by the patient at home .
This is meant to provide melanoma patients and their families with information on the programs and services available to help them finance the cancer treatment and the costs incurred.
Mind the gaps: Expectations vs. realities for many cancer patients
Many Canadians expect their cancer system to work for them may significantly differ from the reality they may encounter. Depending upon the province, patients may be surprised to encounter five gaping holes in their provincial cancer systems:
- Completely different provincial systems for IV and oral (or other take-home medications)
- Widely different timelines and waiting periods to commence IV and oral cancer medications
- Outdated paper-based systems in some provinces that, in 2014, still rely on hand-written prescriptions, mail and fax machines
- Lack of ability to track and report on usage, effectiveness and side effects of all cancer drugs
- Different levels of care: that not all cancer drugs are dispensed to patients by oncology-trained professionals
Read more on the article here!
Cancer drugs and prescriptions
Cancer drugs work to eliminate cancer cells, stop their spread and slow down the growth in different ways; drugs may also be used to lessen or relieve the side effects of cancer or treatments. In Canada, drugs are often paid for by public provincial drug plans, employer/private insurance plans, and/or out of pocket . Still, cancer patients, caregivers and their families can find themselves paying exorbitant amounts for cancer drugs.
Drug coverage across the provinces at a glance
To highlight some of the inconsistencies in cancer drug coverage across the country, CanCertainty released a white paper by the Cameron Institute, a public policy think-tank, which details the patchwork of provincial cancer coverage :
- Canadians living in British Columbia, Alberta, Saskatchewan and Manitoba have their cancer drugs paid by the provincial government regardless of their age, income level or whether they are intravenously or orally administered
- Provinces such as Ontario and the four Atlantic provinces do not primarily fund oral or injectable cancer medications. Patients needing take-home cancer medications fall back on a complex patchwork of partial assistance that may include their provincial drug plan (if eligible), private insurance (if any), manufacturers’ assistance programs (if any), fundraising (if possible), and personal savings and assets (if available) 
- Through different funding methods, Canadians in Quebec have both intravenous and oral cancer drugs reimbursed regardless of age or income level
- Oral, take-home cancer drugs are covered by the territorial governments but sometimes only with deductibles of less than $500
New Brunswick is currently phasing in the New Brunswick Drug Plan: this will cover individuals regardless of age, gender or pre-existing medical conditions.
The New Brunswick Drug Plan is available to all New Brunswick residents who:
- have an active Medicare Card;
- do not have existing drug coverage (through a private plan or a government program); or
- have existing drug coverage that does not cover a specific drug that is included in the drug plan formulary or the resident has reached their yearly or lifetime maximum for that drug coverage
Phase 1 of the New Brunswick Drug Plan went from May 1, 2014 – March 31, 2015; enrolment in this phase is voluntary for New Brunswick residents who have a valid Medicare card. Phase 2, which came into effect on April 1, 2015, makes it mandatory for all New Brunswickers to have prescription drug insurance, whether through private insurance or enrolment in the New Brunswick Drug Plan .
To find more information about the drug plan and how to enrol please visit the Government of New Brunswick website.
Cancer drug coverage in Ontario and Atlantic Canada
Only certain provinces and territories will pick up all of the cost of cancer drugs listed on their formularies; for example, patients in Ontario and Atlantic Canada are subject to different reimbursements. Even for those with private insurance, many patients and their families residing in Ontario and Atlantic are still paying high costs.
Drug Coverage.ca offers information on reimbursement for prescription medications by providing information on types of private insurance plans, provincial/ territorial drug benefit programs, drug funding by provincial cancer agencies, and federal drug plans available in Canada.
Reaching out for financial advice from the healthcare team of the cancer patient is another excellent way to gain more information or point the individual in the direction of a pharmacist, pharmacy technician or social worker who can provide guidance .
Provincial drug plans and formularies
Formularies across the provinces
Health Canada drug product database – A database provided by Health Canada to search for drug identification numbers, product names and company names
BC PharmaCare formulary search – Provides a search engine for the formulary of BC PharmaCare and links to other cancer agencies’ formularies in British Columbia
Alberta drug benefit list – A formulary for the Alberta Health Care Insurance Plan; includes medicines covered under other plans
Saskatchewan cancer agency drug formulary – Saskatchewan Cancer Agency provides a formulary of the anti-cancer drugs and some supportive drugs funded by the agency
Saskatchewan online formulary database – A formulary of all the medicines covered underneath the Saskatchewan Drug Plan
Manitoba drug benefits and interchangeability formulary – A formulary for all the drugs which have been approved as eligible benefits under the Pharmacare drug benefit program.
Ontario drug benefit formulary/comparative drug index – A search engine that shows the formulary of drugs available under the various reimbursement programs in Ontario
Quebec list of medications – A formulary of the medications covered by Quebec’s basic prescription drug insurance plan
New Brunswick prescription drug program formulary – A formulary of the drugs which are eligible for benefits under the New Brunswick Drug Plan
Nova Scotia Pharmacare – A formulary that details the drugs and devices available for benefits under the Pharmacare programs in Nova Scotia
P.E.I. Pharmacare formulary – A formulary of the medications approved for coverage in Prince Edward Island as a public service
Newfoundland and Labrador interchangeable drug products and formulary – A formulary that lists the drugs which are covered by the Newfoundland and Labrador
Prescription Drug Program
Nunavut non-insured health benefits program – The Extended Health Benefits Full Coverage Plan covers those enrolled in the Nunavut Health Care Plan and have a chronic illness or disease; this list approved prescription drugs
North-West Territories health centre formulary – The Extended Health Benefits Full Coverage Plan covers those enrolled in the Nunavut Health Care Plan and have a chronic illness or disease; this list approved prescription drugs
Yukon drug formulary – A search directory of the formulary for the drugs covered by the Yukon Insured Health Services
Provincial financial information and resources
Canadian cancer society – Financial help – The Canadian Cancer Society provides financial help and advice specific to the province or territory where the patient and family resides
Wellspring – Money matters – Wellspring provides information on government income programs, community resources and support to help cancer patients cope with the financial difficulty that can come with a cancer diagnosis.
BC Cancer agency – Financial and healthcare coverage information – Further financial information and assistance for cancer patients residing in British Columbia
CancerCare Manitoba – Financial arrangements – Services are provided by CancerCare Manitoba to help cancer patients understand Manitoba’s drug coverage programs
CancerCare Ontario – Cancer drug reimbursement – Information on programs that approve cancer drugs for Ontario patients that may not otherwise be available for reimbursement
CancerCare Nova Scotia – Finances and other concerns – Information and advice for cancer patients living in Nova Scotia
Cancer care foundation Newfoundland – Patient and family support fund – A support fund established to help cancer patients who are experiencing financial hardship
Federal programs and funding may be eligible for prostate cancer patients should they or a family member qualifies be employed be the Canadian Forces or fall under other criteria of the programs.
Canadian forces health services – The Canadian armed forces drug benefit list – A formulary of the drugs available for coverage to CF members and other eligible persons
Canadian forces health services – Spectrum of care – Medical and dental benefits and services – Further describes the health benefits and services available to CF members and other eligible persons
Interim federal health program – A limited temporary coverage of health-care costs to protected persons not eligible for provincial or territorial health insurance plans and when a claim cannot be made under private health insurance
Service Canada – Employment insurance compassionate care benefits – Compassionate care benefits are benefits paid to people who have to be away from work temporarily to provide care or support to a family member who is gravely ill and who has a significant risk of death within 6 months; a maximum of six weeks may be paid to eligible people
Health Canada – Non-insured health benefits – Provides a range of medically necessary goods and services to eligible First Nations (including registered Indians under the terms of The Indian Act) and recognized Inuit clients in Canada.
Veterans affairs Canada – Veterans Affairs Canada (VAC) provides a wide range of benefits and services, including prescription drugs, to qualified veterans, still-serving Canadian Forces members, RCMP members, and certain civilians as well as their dependants and survivors.
Medical expenses tax credit – Medical expenses that can be claimed for oneself, a spouse or common-law partner, or dependent children born in 1996 or later; if a patient or caregiver is spending more than 3 per cent of their income on medical expenses, then they can claim these expenses for the tax credit .
Health Canada – Disability tax credit – A person with a disability or their caregiver may be able to claim on their income tax and benefit return the deductions and tax credits; here is a list of what they could claim
Health Canada – Special access programme – The Special Access Programme (SAP) provides access to non-marketed drugs for practitioners treating patients with serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable
Private health insurance
The majority of Canadians have private insurance/third party insurance for prescription drugs as part of health benefits provided by their employers; most plans also cover the employee’s family or dependants. Employers purchase these plans from insurance companies and determine the terms of the plans for their employees.
Private insurance plans will cover some or all of the prescription medications that are used on an outpatient basis. This can include oral, inhaled and injectable medications, or some drugs for intravenous infusion used in an ambulatory setting. Private plans do not usually pay for medications used for patients staying in the hospital .
How to find out if the medication is covered
- Phone the insurance carrier to determine the extent of your coverage
- Supply the insurance company with the policy number or group health benefits number
- Know what the drug identification number (DIN) of the medication 
Private health insurance resources
Drugcover.ca – Private insurance – A guide on understanding if a private insurance company will pay for prescriptions, private insurance plans, special authorization, and the reimbursement methods
Health Canada – Drug product database – The drug product database contains specific information on drugs approved for use in Canada
Canadian life and health insurances association (CLHIA) – A full listing of Canadian insurance companies
Patient assistance programs (PAPS)
Pharmaceutical company-sponsored patient assistant programs (PAPS) help a patient find other payment options or provide financial assistance for their own drug plans; navigating private drug plan coverage can be challenging but pharmaceutical companies can provide trained staff members who help patients navigate their available coverage options .
Cancer centre coverage
Cancer treatment centres will sometimes provide financial assistance to patients in emergency situations when funding from other sources and services is not available. Contact the Patient and Family Counselling department at the nearest regional Cancer Centre and ask about financial assistance options available for patients.
Medical expenses and out-of-pocket costs
The Canadian Cancer Society identifies four groups of people as being most at-risk of suffering high out-of-pockets costs during cancer treatment: rural residents who must travel for treatments, those not covered with private insurance, those with high drug costs, and those who suffer a significant loss of salary .
Travelling for treatment can take a heavy toll on the finances of the patient and their family; in a study of 484 adults presented for cancer care at clinics in Newfoundland and Labrador, 19.5% of rural patients paid more than $1000 in travel-related costs for a single to access cancer care .
Further resources for out-of-pocket costs
Service Canada – Canada pension plan disability benefit – A taxable monthly payment that is available to people who contributed to the CPP and are not able to work regularly at any job because of a disability; the disability benefit does not pay for medications and assistive devices
Service Canada – Employment insurance sick benefits – EI offers up to 15 weeks payment for people who are eligible; this is based on how many weeks have been paid into the plan, and the payments are based on weekly earnings
London health sciences centre – Claiming medical expenses on your income tax returns – Info on what can be claimed as medical expenses on your income tax return, this can include travel costs, drugs and more
Canadian cancer society – Financial help – Depending on the province, the Canadian Cancer Society may be able to provide financial help with costs of travelling and lodging
 Nelson, Colleen. “The Financial Hardship of Cancer in Canada: A Literature Review.” Review. Candian Cancer Society 2010: 1-26.Canadian Cancer Society. Canadian Cancer Society Manitoba Division, 2010. Web. accessed 04 June 2014.
 “Chemotherapy and Other Drug Therapies.” Canadian Cancer Society. Canadian Cancer Society, n.d. Web. accessed 04 June 2014.
 Taylor, Wayne. “A Business Case for the Universal Coverage of Oral Cancer Medicines.” (n.d.): n. page. Cameron Institute. Cameron Institute, Jan. 2014. Web. accessed 04 June 2014.
 News, CBC. “Oral Cancer Drugs: Group Pushes for Universal Coverage.”CBCnews. CBC/Radio Canada, 10 Mar. 2014. Web. accessed 04 June 2014.
Maskens, Deb. “Will That Be for Here or to Take Out?” CanCertainty. CanCertainty, 29 Jan. 2015. Web. 22 July 2015.
 Taylor, Wayne. Figure 8: Eligiblity for Public Coverage of Oral Cancer Drugs Taken at Home. Digital image. Cameron Institute. Cameron Institute, Jan. 2014. Web. accessed 04 June 2014.
 “New Brunsick Drug Plan: Questions and Answers.” Questions and Answers. New Brunswick Government, n.d. Web. accessed 04 June 2014.
 Taylor, Paul. “Financial Aid for Costly Cancer Drugs.” Personal Health Navigator. Healthydebate, 24 Sept. 2013. Web. 04 June 2014.
 “Cancer Drugs – Frequently Asked Questions – CCO.” Cancer Care Ontario. Cancer Care Ontario, 06 Jan. 2014. Web. accessed 06 June 2014.
 Taylor, Paul. “The Costs of Being a Cancer Patient.” Healthydebate. Personal Health Navigator, 4 Feb. 2014. Web. accessed 09 June 2014.
 “Private Insurance.” Private Insurance. Drugcoverage.ca, n.d. Web. accessed 09 June 2014. .
 Lepage, Suzanne. “Patient Assistance Program Primer.” Benefits Canada. Benefits Canada, 12 Mar. 2013. Web. 09 June 2014.
 Nelson, Colleen. “The Financial Hardship of Cancer in Canada: A Literature Review.” Review. Candian Cancer Society 2010: 1-26.Canadian Cancer Society. Canadian Cancer Society Manitoba Division, 2010. Web. accessed 09 June 2014.
 Mathews, M. and Park, A. (2009 b). Identifying Patients in Financial Need: Cancer Care Providers’ Perceptions of Barriers. Clinical Journal of Oncology Nursing, 13(5), 501-505.