Health Canada has derailed a long-fought effort to establish a framework for orphan drugs. Last month the agency, without warning, removed from its website all documents relating to the effort. The agency says its conducting a broader review of regulations and will now seek to address the aims of the orphan drug framework through other means. The decision is a blow to rare disease advocates in Canada, who view the move as a response to provincial governments who feared an orphan drug designation would be a license to charge high prices for medications. We spoke Durhane Wong-Rieger, president and CEO of The Canadian Organization for Rare Disorders, about the Health Canada’s unexpected decision, why an orphan drug framework is seen as critical to making needed therapies available in Canada, and what it means for the rare patient community there.