Decisions to reimburse medical devices in Canada are highly de-centralized. In Canada, most of the tests used for PM are Laboratory Developed tests (LTDs). This is because Cdx tests are replaced by LTDs and are subject to provincial regulation and oversight. The vast majority of decisions concerning reimbursement rates are made by hospitals, who normally receive global funding for providing services. When a CDx is mandatory to performed and extra funding is needed, pharmaceutical companies pays for the costs (http://www.thejournalofprecisionmedicine.com/wp-content/uploads/2015/10/DUBOIS.pdf). This payment mechanism is followed also by many European countries as it will be described.
