New research by scholars at the University of Pittsburgh shows how bad access to new cancer medicines is in Canada, especially compared to the United States:

Of 45 anticancer drug indications approved in the United States between January 1, 2009, and December 31, 2013, 64% (29) were approved by the European Medicines Agency; 76% (34) were approved in Canada; and 71% (32) were approved in Australia between January 1, 2009, and June 30, 2014. The U.S. Medicare program covered all 45 drug indications; the United Kingdom covered 72% (21) of those approved in Europe— only 47% (21) of the drug indications covered by Medicare. Canada and France covered 33% (15) and 42% (19) of the drug indications covered by Medicare, respectively, anad Australia was the most restrictive country, covering only 31% (14).

The U.S. Food and Drug Administration appears to be a less restrictive bureaucracy than its counterparts in other developed countries. Allowing patients to use new medicines without the interference of a government bureaucracy should be pretty straightforward, as long as they are aware of the risks. Evidence published by the Fraser Institute shows delayed access to cancer meds in Canada has reduced patients’ survival.

Coverage is more ambiguous. Both U.S. Medicare and other countries’ single-payer systems are funded by taxpayers. Reimbursing expensive cancer drugs has to be balanced will all the other claims on limited government budgets. As long as patients are free to pay out-of-pocket, it may not be appropriate for taxpayers to pay the entire cost of each drug. However, cancer is the textbook diagnosis of a catastrophically expensive diagnosis, when we expect insurance to kick in. If insurance does not cover a wide portfolio of drugs that demonstrate therapeutic benefits, it’s not good insurance.

When we look at approval and coverage combined, the results are appalling. Of 45 drugs covered by U.S. Medicare, Canadian public payers covered only 15. The article describes cancer coverage decisions in Canada being influenced by the Canadian Association for Drugs and Technologies in Health, which conducts assessments funded by provincial drug plans. Each provincial drug plan makes its own decision about coverage. The article does not specify whether it considers a new cancer drug covered in Canada if only one provincial plan covers it, or a majority, or all. The results are appalling nevertheless.

Drug coverage for American seniors is provided by U.S. Medicare. Although funded by taxpayers, it’s not provided by a government agency. Rather, private insurers compete to offer coverage within regions. Low bidders win the contracts. Since its introduction in 2005, the program has come in way under budget. A recent analysis indicates the drug program has reduced overall costs to U.S. Medicare by keeping patients out of hospitals, among other benefits.

This competition among private insurers has ensured better access to new cancer drugs than Canada’s provincial drug plans have. Provincial governments, which have already offered public drug plans to seniors and other residents, should consider reforms along similar lines.