Sabrina Apitz-Grossman received a prognosis 13 months ago indicating that she had a limited time left, estimated between 12 to 18 months. Diagnosed with a rare form of cancer that had spread from her knee to her lungs, the 31-year-old underwent various treatments like radiotherapy, chemotherapy, and surgeries, but the synovial sarcoma remained unremovable. Her medical team advised a treatment approved in the US, unavailable in Ontario, which she urgently requires. Despite her appeals, including the Case-by-Case Review Program, for permission to undergo treatment at the Princess Margaret Cancer Centre in Toronto, she faces obstacles.
Expressing her determination, Apitz-Grossman stated her strong desire to celebrate her 32nd birthday. Along with other Stage 4 cancer patients in Ontario, she felt a glimmer of hope following the successful court challenge by 37-year-old Alex Shved, who was in a similar situation and fought against his OHIP out-of-country refusal.
However, their optimism was short-lived as Health Minister Sylvia Jones responded to the court ruling by introducing new regulations. The revised policy stipulates that out-of-country drug treatments will only be funded if they are already funded within the province but temporarily inaccessible. Some patients find these criteria too stringent, viewing the government’s move as prioritizing cost-saving over saving lives.
Challenging the notion of cost-saving measures, Apitz-Grossman questioned whether sacrificing lives to cut costs was justifiable. She highlighted the high cost of the treatment she seeks, Tecelra, a personalized therapy derived from a patient’s T-cells. Despite feeling guilty about the expense, she emphasized her strong will to live.
The $5.2 billion cost-saving figure cited by Jones lacked clarity in its origin, with subsequent explanations detailing potential additional costs if the province ceased price negotiations with drug manufacturers for public coverage. OHIP’s rationale for denying out-of-country treatment funding revolves around maintaining the incentive structure for drug manufacturers participating in Canada’s drug review processes.
Among other patients, Kevin Nash, diagnosed with metastatic melanoma, faced denial for a similar treatment as Shved. Nash criticized the government’s reasoning, emphasizing the substantial profits of drug companies compared to the cost of individual treatments. In Apitz-Grossman’s case, the manufacturer of Tecelra has no intentions of applying for approval in Canada, rendering the review process argument irrelevant.
Holly Wardlow, battling a rare liver cancer, encountered denial of coverage for her treatment under the Case-by-Case Review Program, despite the manufacturer’s confirmation of no plans for Canadian approval. Resorting to personal finances and crowdfunding for treatment, Wardlow’s situation exemplifies the challenges faced by patients denied access to life-saving treatments.
