TABLE VI.

Disparities in Canadian drug reimbursement guidelines for aromatase inhibitors (ais)

Quebec	No standard provincial guidelines Hospital pharmacy and therapeutics committees decide chemotherapy usage with formulary listing Régie de l’assurance maladie du Québec covers oral and intravenous chemotherapies Seniors 65 years of age and older have the choice of exclusive third-party insurance, if required, with open, unrestricted coverage for AIs and tamoxifen
Ontario	Cancer Care Ontario Clinical Practice Guideline or Evidence Summary used for reimbursement decisions on anticancer agents, reviewed by multidisciplinary Disease Site Groups ais are associated with some limited-use criteria in Ontario Drug Benefit program Ontario Drug Benefit covers seniors over 65 years of age, residents of long-term care facilities and Homes for Special Care, recipients of professional services under home care, and people on social assistance Trillium Drug Program covers those ineligible under Ontario Drug Benefit and lacking private insurance; requires patient deductibles and co-pays Third-party insurers also cover oral and hormonal therapies, supportive care outpatient treatments
Saskatchewan	Restricted public coverage of AIs
Manitoba	Manitoba’s Pharmacare Program reimburses AI therapies once patient deductibles are met
British Columbia	Public-sector reimbursement of AIs restricted, interchangeable, and based on prognostic factors Upfront therapy with an AI for women with an elevated risk of early relapse, defined as high grade or low estrogen receptor (1+) disease or stage III (including any N2/N3, T4, or T3N+) and excludes women with low-grade T1N0 tumours Sequential therapy is preferred for most postmenopausal women who are not at high risk for early relapse:  Early switch to an AI for 2–3 years after 2–3 years of tamoxifen  Late switch to an AI for 3 years after 3–5 years of tamoxifen, or if postmenopausal after 3 years of tamoxifen
Atlantic Canada	No specific guidelines on AI use Second-line AI therapy for patients who have failed, are intolerant of, or have an absolute contraindication to tamoxifen (with the exception of Nova Scotia)