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Ontario court overturns OHIP refusal to fund U.S. cancer treatment

Ontario court overturns OHIP refusal to fund U.S. cancer treatment

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An Ontario court has overturned a decision denying out-of-country coverage for a 37-year-old father with stage four melanoma and ordered the province’s health insurance program to reconsider his case and issue a new decision by October 2.

 

Alex Shved, a father of two from Etobicoke, had sought public funding to receive tumour-infiltrating lymphocyte therapy, or TIL therapy, in the United States after his oncologist recommended the specialized treatment.

 

The therapy involves removing immune cells from a patient’s tumour, expanding them in large numbers and returning them to the body to help attack cancer cells. Shved’s doctors recommended treatment at the Moffitt Cancer Center in Florida after his cancer progressed and spread to his bones and lungs despite previous treatments.

 

The court’s majority found problems with the reasoning used to deny the request, including the argument that funding treatment for Shved could affect future negotiations over the therapy’s price and its potential inclusion in Ontario’s publicly funded health system.

 

A dissenting judge agreed that the refusal should be overturned but said the court should have gone further by directing provincial officials to recommend funding and expedite a new decision.