Updated April 2021

NDFP - Introduction

Introduction

 

The New Drug Funding Program (NDFP), Evidence-Building Program (EBP), and High-Cost Therapy Funding Program (HCTFP) are publicly funded drug programs under the Ministry of Health. These programs reimburse Regional Cancer Centres (RCCs) and hospitals for the costs of cancer drugs.  Reimbursement is contingent upon compliance with patient eligibility criteria developed based on evidence-based guidelines that are approved by the Ministry of Health. In addition to being used for reimbursement, data is used to support cancer system planning for systemic therapy.

The eClaims database maintains a record of both patient eligibility/enrollment data and treatment data. To be eligible for reimbursement through the NDFP, EBP, or HCTFP, the hospital must submit eligibility/enrollment data as well as treatment data in compliance with monthly billing deadlines.

The table below outlines the data that are captured. The eligibility/enrollment data are described in very general terms for the purpose of the Data Book and includes only core elements required for all drugs and indications reimbursed through the NDFP/EBP/HCTFP. The series of data elements related to the specific medical circumstances under which patients are eligible for reimbursement are not included in this document since they vary depending on the drug and indication and are not considered to be core data sets. Specific to the EBP, supplemental forms are required as a condition of participation and must be submitted at specific times to ensure continued reimbursement. Supplemental forms are also required following the completion of therapy. They assist with continued real-world data collection, in order to do the analyses that inform permanent funding decisions. The specific details (including a description of the detailed medical circumstances where the drug will be reimbursed) of the most up to date eligibility/enrollment criteria for each drug and indication reimbursed within the NDFP, EBP, and HCTFP are posted on Cancer Care Ontario’s funding and reimbursement webpage.

Each patient for whom the RCC or hospital is seeking reimbursement must be enrolled in the NDFP/EBP/HCTFP by providing eligibility/enrollment data that include patient-specific demographic information and answers to a series of medical questions. The enrollment process for each patient takes place once for each drug and indication for which reimbursement is sought. The specific eligibility/enrollment criteria for the NDFP/EBP/HCTFP may change as new drugs and treatment indications are added to the program or as policy decisions concerning current reimbursement benefits are revised. The treatment data described below must be submitted on a monthly schedule (first day of the second month following treatment, e.g., April treatment claims are due by June 1).