Limited funding of Herceptin

Limited funding of Herceptin

May 12, 2011

12 May, 2011

The Ministry of Health and Long-Term Care agreed to fund Herceptin for patients with breast cancer tumours of one centimetre in diameter or less. The Ombudsman suspended his investigation in May 2011, but he continues to monitor complaints and developments on the issue.

The Ministry of Health and Long-Term Care agreed to fund Herceptin for patients with breast cancer tumours of one centimetre in diameter or less. The Ombudsman suspended his investigation in May 2011, but he continues to monitor complaints and developments on the issue.
 

 

Case update - Annual report 2011-2012

In March 2011, the Ombudsman launched an investigation into the Ministry of Health and Long-Term Care’s decision not to fund the drug Herceptin for breast cancer patients because their tumours were too small – i.e., one centimetre in diameter or less.

Two months later, the Ombudsman suspended his investigation when the Ministry announced it would extend funding to these patients through a new Evidence Building Program (EBP). The program would allow for the collection of real-world data on clinical and cost effectiveness where there is evolving but incomplete evidence of the benefits of a cancer drug.

Although the investigation was suspended, the Ombudsman asked the Ministry for regular updates on the implementation of the EBP. The Ministry obtained stakeholder input in the summer of 2011 regarding the program’s policies and framework. As of February 2012, 45 patients including Jill Anzarut, who first brought the issue to the Ombudsman’s attention, had been approved to have Herceptin funded through the program. The Ministry and Cancer Care Ontario continue to consider using the EBP process for other conditions and other drugs. Ms. Anzarut’s recovery is going well.
 

Case update - Annual report 2010-2011

The Ombudsman asked SORT to assess the issue of the Ministry of Health and Long-Term Care’s limited funding of Herceptin after receiving a complaint on February 28, 2011 from Jill Anzarut, a breast cancer patient who was denied funding for the drug because her tumour was too small. On March 18, 2011, he announced an investigation into the Ministry’s decision not to provide funding for the drug to breast cancer patients whose tumours are less than one centimetre in diameter.

The Ombudsman’s investigation focused on whether or not the Ministry’s decision to limit the funding was informed and reasonable. SORT interviewed seven patients in a similar situation to Ms. Anzarut and reviewed policies in other jurisdictions.

On May 12, 2011, the Ombudsman suspended his investigation after the Ministry decided it would fund Herceptin to treat tumours of one centimetre or less, as the first drug covered by its new Evidence Building Program.

Although the investigation was suspended, the Ombudsman asked the Ministry for regular updates on the implementation of the new program and will continue to monitor developments and complaints regarding this issue.