opinion: what the rest of canada can learn from ontario's fast drug program
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the fast program should not only help ontarians, but canadians across the country gain access to cancer drugs.
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as oncologists, we sit with patients and families at moments when time is not abstract. we see what it means when a new treatment or diagnostic test can offer more months of disease control, fewer symptoms, or the chance to keep working, parenting, travelling and living with greater confidence. because of these advances, many canadians with cancer are living longer, better and more productive lives.
but in the clinic, we also see the other side of innovation: the patient whose oncologist can point to a promising treatment approved by health canada, but cannot yet offer it through the public system. too often, lengthy delays between regulatory approval and provincial funding stand in the way. in canada, those delays are frequently treated as unavoidable. they are not. in many cases, slow access is less about scientific uncertainty and more about policy choices and process design.
ontario’s funding accelerated for specific treatments (fast) initiative has shown that governments can shorten those delays and get important medicines to patients sooner. the practical question now is whether the rest of canada is prepared to learn from that experience.
as canada’s first ministers prepare to meet in prince edward island for the council of the federation, they will be looking for practical ways to strengthen health systems and improve outcomes for canadians. faster access to carefully reviewed cancer medicines should be part of that discussion.
canada’s drug review and reimbursement process is rigorous, and it should be. patients deserve confidence that new treatments have been thoroughly evaluated for safety, effectiveness, and value. the problem arises after that review is complete, when separate steps in the system can turn into months of additional waiting.
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even after health canada grants approval, patients often face many additional months, and sometimes years, before publicly funded access becomes available. health technology assessments, pricing negotiations and provincial funding decisions typically occur one after another rather than in parallel. each step has a purpose. but taken together, they can produce a system that moves far more slowly than cancer does.
for people living with cancer, these delays are not merely administrative. they can mean waiting to control disease progression, waiting for symptom relief or missing the window when an innovative therapy may offer the greatest benefit. they can mean dying prematurely or unnecessarily.
this is why ontario’s fast initiative deserves attention.
introduced last year, fast was designed to shorten the period between health canada approval and public reimbursement for certain cancer medicines. the program allows eligible therapies to become available to patients while pricing negotiations continue, rather than requiring patients to wait until every step of the reimbursement process has concluded.
fast matters because it has shown that the system can move differently. it has demonstrated that wait times can be reduced without compromising patient safety, lowering regulatory standards, or abandoning prudent management of public resources.
we do not believe that should be treated as a one-off exception. it should be treated as a model to improve and scale.
currently, eligibility for fast is limited primarily to a small number of oncology medicines reviewed through project orbis, an international collaboration among regulatory agencies. while this has provided an important proof of concept, there is a strong case for expanding the program’s reach.
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one option would be to extend the accelerated funding pathway to oncology medicines that receive health canada’s priority review designation. priority review is reserved for medicines intended to treat serious, life-threatening or severely debilitating conditions and that either address unmet medical needs or provide significant therapeutic advances over existing options.
if a medicine has been deemed important enough to warrant an accelerated health canada review because of its potential benefit to patients, we believe it is reasonable to ask why patients should then enter a reimbursement process that proceeds at the usual pace.
as premiers gather this summer in prince edward island, ontario’s leaders should make the case for fast not simply as an ontario success story, but as a canadian project to improve cancer care across the country. they should urge canadian leaders to build on ontario’s experience and extend a faster, responsible access pathway to more cancer treatments and more patients. a person’s access to an important cancer medicine should not depend so heavily on their postal code.
in cancer care, time matters. when a faster path already exists, canadians should not have to wait for governments to use it.
dr. sandeep sehdev and dr. nancy nixon are co-chairs for the cancer clinician advocacy forum (ccaf).
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