We asked medical oncologists in our network for their opinions on drug access and public funding.
Here are the highlights:
- Almost all respondents (90%) felt that a drug should receive public funding even if there was no overall survival (OS) benefit as long as there was an improvement over standard of care (SOC) in terms of progression free survival (PFS), and/or quality of life(QoL).
- Some physicians (14%) felt that a drug should be publicly reimbursed if priced lower than standard of care.
- Approximately 90% of respondents felt that if there was a 3 month OS benefit, a drug should receive public funding. All respondents felt that a 4 month OS benefit should lead to public funding.
If a new drug is marketed with no OS benefit over SOC, should the drug receive public funding?
What degree of OS benefit is required for public drug funding?
If you feel drug funding should be approved based on PFS alone, what degree of PFS benefit is sufficient?
Do you agree with the following statement? "Every new drug should have a compassionate access program made available by the pharmaceutical manufacturer."
KeyOps KOL Feature
"New drugs need time to get public finding. Early free drug from a (life sciences) company allows early adoption of therapy."
Dr. Alan So, British Columbia
Please indicate why you made your selection.
Please describe if and how provincial cancer organizations (i.e. CCO/BCCA) support the use of compassionately funded medications at your center.
What is an acceptable total lag time between Health Canada approval, pCODR/CADTH funding decision, and then approval on the provincial formulary?
New oral agents are approved for use in the third-line setting for metastatic bladder cancer. Until recently, it was only available by Health Canada Special Access. Do you feel your centre has adequate resources to apply to Health Canada and administer SAP drugs?
Do you use Cost/QALY to decide which treatments to offer a patient?
Should public funding cover drug rechallenges, i.e. the patient previously progressed on systemic therapy A and then moved on to other drug options, or should public funding cover the costs of trying systemic therapy A again?
Please indicate why you made your selection.
Respondent profile
12
Average years in practice
We partnered with Dr. Dorothy Lo, a medical oncologist based on Toronto, Ontario, who has provided a reflection of her thoughts on the results of the survey:
This study showed that many physicians feel that drugs are effective even if there is no demonstrated OS benefit and physicians seem to place weight on PFS and QoL benefit. It seems like the current standard for funding decisions weigh heavily on OS. These findings may show changing attitudes and the willingness to support access to drugs using other metrics than OS. It is noted that cost savings may also warrant justification for new drug funding.
Some unmet needs were identified and highlighted. The expressed expectation regarding compassionate access programs reflects the current lag times between Health Canada approval to public reimbursement. Many new drugs are currently supported by compassionate access programs offered by pharmaceutical companies. It is unclear if there is a consensus of what the optimal timeline should be as the range of responses regarding an acceptable lag time between Health Canada approval to pCODR/CADTH funding decision and then approval on the provincial formulary ranged from 1 month to 1 year. Another unmet need that was highlighted included suboptimal support from provincial cancer organizations for the use of compassionately funded medications as more than half (52%) of responding physicians felt there was lack of support for the use of compassionately funded medications at their center.