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Case-by-Case Review Program (CBCRP)

Application Instructions Reimbursement Instructions

The Case-by-Case Review Program (CBCRP) considers funding requests for oral and injectable cancer drugs for patients with a valid Ontario Health Card. Patients are eligible for CBCRP funding if their situation meets all of the following criteria:

  • The drug is intended to treat an existing cancer.
  • The patient has a rare clinical circumstance that is immediately life threatening (i.e., death is likely to occur within months).
  • There is no other comparable clinical alternative.
  • There are no other funding options (e.g., Ontario Drug Benefit, New Drug Funding Program, Exceptional Access Program).
  • The patient cannot enrol in a clinical trial.
  • Evidence primarily shows that the drug will prolong survival.
  • Treatment may avoid or defer other healthcare costs.

If you are a patient who needs drug coverage for take-home cancer drugs (e.g., chemotherapy pills), you must be eligible for benefits under the Ontario Drug Benefit Program to qualify for this program. People eligible for Ontario Drug Benefit include those over age 65 or enrolled in the Trillium Drug Program.

Medications Covered

This program makes funding decisions based on a patient’s specific clinical circumstance and the drug requested. Any cancer drug not currently publicly funded in Ontario can potentially be funded under this program if the case meets the program’s eligibility criteria listed in the Case-by-Case Review Policy for Cancer Drugs, and summarized here:

The program accepts requests for:

  • injectable cancer drugs (e.g., intravenous chemotherapy) administered in outpatient hospital or cancer centre clinics
  • take-home cancer drugs (e.g., chemotherapy pills)
  • coverage to continue cancer drugs previously supplied through a clinical trial, if the patient’s case meets the program’s eligibility criteria
  • coverage previously paid for by other means (such as a third-party payer), if the patient’s case meets the program’s eligibility criteria

The program does not accept requests for:

  • interim funding for new cancer medications that are expected to be reviewed or are under review for public funding
  • cancer medications that have been reviewed and rejected for funding under another public program for the same type of cancer

View the submission and funding status of new cancer medicines:

How to Apply

If you are a patient, your oncologist must apply on your behalf. Requests are accepted only from oncologists who are licensed to practice in Ontario.

If you require coverage for a take-home cancer drug (e.g., chemotherapy pills), your oncologist should verify that you are eligible for the Ontario Drug Benefit program before applying to the Case-by-Case Review Program. In some cases, you may need to register in the Trillium Drug Program to qualify for benefits under the Ontario Drug Benefit program.

If you are an oncologist, see the Application Instructions for detailed information on how to apply to the Case-by-Case Review Program.
 

Review Timelines and Process

We aim to provide a funding decision within 2 weeks after an application has been submitted with all supporting documents. This program is not meant for acute or emergency therapy.

These timelines account for a thorough review process for requests that meet all the criteria for review. The review process includes these steps:

  1. At least 2 provincial cancer experts review the application.
  2. We provide a funding recommendation to the Executive Officer of Ontario Public Drug Programs.
  3. The Executive Officer reviews each request and makes the final decision to approve or reject a request for funding.
     

Duration of Coverage

How long coverage will last is decided on a case-by-case basis. Factors considered in the decision include:

  • the best available evidence
  • the treatment plan
  • expert opinion

Renewal of Coverage

A patient’s oncologist can apply for a renewal if the patient has responded to the treatment and the coverage period has ended. If a renewal is requested, provincial cancer experts will assess the patient’s response to the treatment as part of the review process. To avoid an interruption in reimbursement, oncologists should apply at least 3 weeks before administering the last funded dose.
 

Policies

Case-by-Case Review Policy for Cancer Drugs
Information on the program’s scope, criteria, review process and the conditions of reimbursement

Appeals Policy
Outlines when and how an appeal can be filed and the assessment process
 

Contact Information

If you have questions about program eligibility or the application process, email the Case-by-Case Review Program.