Federal health plan denies coverage for cancer drug; patient obtains it through partner’s insurance

Sophie Djeme-Mi Koumazock, a 43-year-old federal public servant in Quebec City and mother of four, was denied coverage for the drug Truqap under the Public Service Health Care Plan after her current medication stopped working, Cbc reported. Her doctor determined she is a candidate for the treatment, which costs up to $12,000 per month. The plan, administered by Canada Life, does not cover Truqap.

Canada Life stated that the Government of Canada determines what is covered under the PSHCP. The Treasury Board of Canada said the plan is designed to supplement provincial and territorial coverage and confirmed that Truqap is not eligible under the prior authorization program. Djeme-Mi Koumazock and her partner have begun using savings and may draw on retirement funds to pay for the drug.

She has been added as a beneficiary to her partner's Beneva insurance plan, which covers Truqap because it follows RAMQ criteria for exceptional drugs. RAMQ stated it is very unlikely that two different insurers would refuse coverage for a medication it accepts. Djeme-Mi Koumazock's oncologist, Dr.

Brigitte Poirier at CHU de Québec-Université Laval, said the efficacy of Truqap is proven by the literature and that changing treatment is necessary when control of the disease is lost. She noted it is not easy for a 43-year-old patient with young children.

A second federal employee, Samson, was also denied Truqap coverage under the PSHCP after her metastatic breast cancer stopped responding to prior medication in December.

Samson obtained coverage through her partner's Manulife plan and the drug manufacturer AstraZeneca in February 2026, and her cancer began to stabilize around March. Medical attorney Patrick Martin-Ménard said contesting an insurance refusal can be a lengthy process that adds to the challenges patients already face.