Ontario Rewrote Its Out-of-Country Drug Funding Rules After a Patient's Court Challenge
Alex Shved, a 37-year-old father of two young children, took the province to court after the Ontario Health Insurance Plan rejected his request for out-of-country cancer treatment. Health Minister Sylvia Jones responded to the court ruling by changing the rules.
Sabrina Apitz-Grossman was told 13 months ago that she had about 12 to 18 months to live. Her doctors are recommending a treatment that is approved in the United States but unavailable in Ontario, and she said it is costly at $727,000 US.
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Framing the change as a cost-saving measure does not sit right with Apitz-Grossman; she asks whether the province is saying it could save 5,000 or more lives and is proud of itself for not doing that.
Her own figure is $727,000 US for the treatment, and she says she feels terrible guilt for seeking something so pricey even though she wants to live. An insurer runs that arithmetic from the other end — which is the whole difficulty of the case, not a gotcha against her.
Her principle is consistency rather than sentiment: she says there has never been a moment when she wished a patient who cost hundreds of thousands of dollars in the ICU had not been saved.