Coverage / Reimbursement of Cancer Medications in Ontario

The Canada Health Act requires provinces and territories to fund all medically necessary hospital and physician services, including drugs used in hospitals. Along with surgery and radiation, medications make up an important part of cancer therapy. Most chemotherapy drugs that are used in the hospital setting and are paid for by either the hospital or by the provincial/ territorial cancer agency.

Cancer patients require different types of medications – chemotherapeutic agents and biologicals that attack the cancer itself, supportive care medications that address the side effects of chemotherapy, anti-nausea drugs, pain medications, antibiotics, antivirals, antifungals and others. Not all of these are used within the hospital setting. Outside hospitals, the provinces and territories provide community based coverage of drugs as supplementary benefits through provincial/territorial drug benefit plans. The plans vary across the country in the amount the beneficiary is required to pay.

Private insurance (third party insurance) plans also provide coverage for medications used outside the hospital. These plans vary considerably with regards to which medications they pay for and the amount the beneficiary pays (if anything) in terms of deductibles and copays.

Hospitals and Cancer Centres – Coverage of Cancer Medications
Ontario Drug Benefit Program / Trillium Drug Program Coverage
Private Insurance Coverage
Federal Drug Plan Coverage
Reimbursement Information for Medications Used in Cancer Treatment

Hospitals and Cancer Centres

The primary payer for cancer medications is the province, which funds cancer medications through hospital drug budgets, the provincial drug benefit plan and the provincial cancer agency.

Cancer patients may receive treatment at cancer centres or at their community hospitals. In either case, these institutions cover the cost of all medications delivered while someone is an inpatient and the cost of intravenously delivered chemotherapy received at the institution. Medications covered are those that are used in the hospitals (most chemotherapy, intravenous antibiotics, others) and some that are used outside the hospital.

Medications that are taken at home are not paid for by the hospitals and may be covered by the provincial drug benefit plan and by private insurance plans. These can include oral chemotherapy drugs, supportive care medications, oral antibiotics/antivirals/antifungals, anti-nausea medications, pain medication and others.

Cancer Care Ontario Web site
Cancer Care Ontario New Drug Funding Program and Drug Formulary

Ontario Drug Benefit Program (ODB) / Trillium Drug Program (TDP)

For eligible clients, The Ministry of Health and Long-Term Care, through the Ontario Drug Benefit (ODB) Program (including clients gaining access through the TDP) pays for most of the cost of prescription drugs that are listed in the Ontario Drug Benefit Formulary. The cost of prescription drug products not listed in the Formulary may be paid by the ODB Program through the Individual Clinical Review (Section 16) Mechanism.

The ODB Program covers medications used outside the hospital (outpatient medications). These can include some chemotherapeutic agents, biologicals, supportive care medications, pain medications, anti-nausea drugs, antibiotics, antivirals, antifungals and others. The medications may be oral, inhaled or injectable. Additionally some drugs for intravenous infusion (infused at home or at a clinic) are covered. For detailed information on the ODB and TDP and drug coverage, click here.

Private Insurance

Medications used outside the hospital (outpatient medications) can be paid for through private insurance (third-party insurance). These can include some chemotherapeutic agents, biologicals, supportive care medications, pain medications, anti-nausea drugs, antibiotics, antivirals, antifungals and others. The medications may be oral, inhaled or injectable. Additionally some drugs for intravenous infusion (infused at home or at a clinic) are covered. Private plans do not usually pay for medications used for patients staying in the hospital (in-patients). For more information on private insurance plans (types of plans, deductibles, copays, special authorization claims, refused claims) click here

Federal Programs

Medications used outside the hospital (outpatient medications) can be paid for through the federally run drug plans. These can include some chemotherapeutic agents, biologicals, supportive care medications, pain medications, anti-nausea drugs, antibiotics, antivirals, antifungals and others. The medications may be oral, inhaled or injectable. Additionally some drugs for intravenous infusion (infused at home or at a clinic) are covered.

Please click on the Plan name below for detailed information on eligibility and drug coverage.

Non-Insured Health Benefits Program
Veterans Affairs Canada
Public Service Health Care Plan
National Defense Health Services
Interim Federal Health Program
Correctional Services of Canada

Reimbursement Information for Medications Used in Cancer Treatment

This table shows commonly used medications and is updated periodically. It may not contain all the possible medications used in cancer therapy.

View Table