Policy priority
Transparency in drug approval and public funding
Patients should be able to understand where a treatment stands, who is responsible for the next decision, and what that decision means for access.
We are calling for clearer public information about regulatory reviews, reimbursement assessments, price negotiations, and funding decisions for pancreatic cancer treatments.
What transparency means here: it does not mean every treatment should be approved or funded. It means decisions, evidence requirements, timelines, and access conditions should be understandable — a drug can be authorized for sale in Canada without being publicly funded for a particular patient or use, and people should be able to see where it stands.
The problem
Parts of the picture are already public. Canada's Drug Agency publishes reimbursement reviews and recommendations; the pan-Canadian Pharmaceutical Alliance (pCPA) publishes negotiation statuses — active, paused, and concluded; public drug plans publish their formularies.
But the pieces sit with different organizations, in different formats, on different timelines. Information is published by several organizations, but patients should not have to assemble the entire picture themselves. We want a clearer, connected account of each treatment's status and the next steps toward access.
An example, as of October 2026: daraxonrasib — the first targeted therapy approved in the United States for metastatic pancreatic cancer — has no Canadian authorization, and no single public record follows it through review, assessment, negotiation, and funding. A patient asking "where does this treatment stand in Canada?" has to piece the answer together across at least four organizations.
Who does what?
Four separate decisions stand between a new treatment and a patient. A positive result at one stage does not establish public coverage at the next.
| Stage | Main responsibility | What it means |
|---|
| Regulatory review | Health Canada | Assesses safety, efficacy, and quality for authorization to sell the drug |
| Health technology assessment | Canada's Drug Agency; INESSS in Quebec | Assesses the evidence and provides advice or recommendations about public reimbursement |
| Price negotiation | pCPA and the manufacturer | Negotiates terms on behalf of participating public drug plans |
| Public funding | The relevant public drug plan or cancer program | Determines coverage, eligibility, and implementation |
These activities may overlap. This is an explanation of responsibilities, not a promise that every drug follows an identical timetable.
Our recommendations
These are the Foundation's recommendations — a proposed position we are putting to the organizations named. They are not commitments those organizations have made.
1
Make treatment status easier to follow
We are asking the organizations involved to maintain a connected public status record for each treatment and indication, showing:
- The decision or process being tracked, and the organization responsible
- Submission, review, and decision dates, where publicly available
- The current status, and the next expected step, where known
- Links to the underlying documents, and the date the record was last updated
Track the indication, not just the drug name — a drug may have different decisions for different uses. This does not require a new agency or a new database; the ask is that existing systems become easier to connect and interpret.
2
Explain timelines and delays
We are asking each organization to publish, for its own stage:
- Applicable service standards or targets, and the actual elapsed time
- Whether a process is paused, and whether additional information is required
- A public explanation of the status, where disclosure is possible, and when the next update is expected
Responsibility should stay specific: not all time between authorization and funding is one organization's delay. The pCPA already publishes process phases, statuses, and target timelines — what is missing is the connected view across all four stages, with elapsed time and reasons in one place.
3
Make decisions and eligibility understandable
We are asking for plain-language summaries of decisions explaining:
- What was decided, and which patients and treatment settings the decision covers
- What conditions apply, and what evidence or uncertainty informed the decision
- Whether there is a public reconsideration or reassessment route, and where patients and clinicians can obtain clarification
This applies to negative decisions as well as positive ones — transparency matters when a treatment is not recommended, or negotiations conclude without agreement. A recommendation to reimburse is not itself a funding decision, and public plans may apply specific coverage conditions.
4
Make provincial implementation visible
We are asking public drug plans and cancer agencies to publish, for each treatment:
- Whether a funding decision has been made, and the effective coverage date
- Eligibility criteria, and any application or prior-approval requirements
- The current status if a decision remains outstanding, and a contact for access questions
A successful pCPA negotiation should not be equated with access in every province: a letter of intent records negotiated terms, and individual public plans still make their own coverage decisions.
Clear accountability, with appropriate protections
We are calling for understandable process information, decision explanations, and access criteria — not publication of patients' personal information or every commercially confidential negotiation detail. Public milestones and meaningful explanations are a realistic standard.
- Transparency: can people understand the status and the decision?
- Timeliness: are processes completed within reasonable expectations?
- Access: can eligible patients actually receive the treatment?
These are related, but improving one does not automatically solve the others.
Our work on this priority
Published
Following one treatment's status
Our explainer on daraxonrasib tracks where a single treatment stands — United States approval, European review, and the Canadian position — and is updated as decisions land.
Is daraxonrasib available in Canada? →
Published
Explaining the process to patients
Our guide sets out the four steps every drug must pass before public plans pay for it, in plain language.
How drug access works in Canada →
In development
A connected status record
We are building the indication-level public record this page calls for — where pancreatic cancer treatments stand at each stage, who is responsible for the next step, and when the record was last updated.
Any support or relationship relevant to this advocacy is disclosed — support never purchases influence over the Foundation's positions. See our transparency page.
How progress will be measured
Whether a patient can answer "where does this treatment stand?" from public information:
- A current, indication-specific status is available
- Milestone dates are published, and the record shows when it was last updated
- A plain-language explanation of each decision is available
- Provincial coverage dates and criteria are published
- The organization responsible for the next step is clearly identified
Trying to understand a treatment's status?
This page sets out the changes we are advocating for. Our patient guide explains how drug approval and public funding work in Canada — the four steps, who decides what, and what each decision means.
Understand the process →