We do lag a bit in approvals — Health Canada is sometimes a year or two behind the FDA, I assume because drug companies prioritise the approval for the U.S. market, then worry about Canada, Europe, etc. later. That said, early access (either to drugs or new ways of using them) is possible via special approval.

The next step is getting the drugs into the provincial formularies and/or getting them approved by private insurers (we don't have universal pharmacare yet, though Ontario is close with prescription-drug coverage for ages 0-24 and 65+, and the Trillium Drug Benefit as a backstop for uninsured people in-between). For critical drugs, manufacturers will often set up patient-access programmes until the drug is covered by private insurers and/or the province.