Objective: To determine the financial impact of sorafenib in the treatment of hepatocellular carcinoma (HCC), the most common form of liver cancer, from a Canadian provincial drug plan perspective for 2008-2010. Methods: A prevalence-based approach was used to estimate the number of HCC patients in Canada. Liver cancer prevalence from 2008-2010 was estimated using the GLOBOCAN 2002 database, supplemented with actual and projected Canadian liver cancer incidence figures from 2003-2010, and survival rates for each stage of HCC. Liver cancer figures were condensed to HCC figures as ~90% of liver cancers are HCC. HCC figures were then segmented using the Barcelona Clinic Liver Cancer staging system and diagnosis rates provided the clinical community. Age and geographic distribution patterns, market share assumptions and provincial drug plan coverage factors were then applied to the HCC figures to determine the number of HCC patients eligible for treatment with sorafenib and coverage from the province. Drug costs including wholesale and pharmacy mark ups were multiplied with the median treatment duration and patient number to determine the financial impact of sorafenib. Results: The prevalence of liver cancer in Canada in 2008 has been estimated to be 1284 increasing to 1324 by 2009 and 1366 by 2010. Of these an estimated 206 HCC patients will be treated with sorafenib in 2008, increasing to 321 in 2009 and 438 in 2010. The number of HCC patients treated with sorafenib that are eligible to receive coverage through their provincial drug plan are 154, 240 and 328 in 2008, 2009 and 2010 respectively. The financial impact of sorafenib to the provincial drug plans is $3.7 million in 2008, $7.1 million in 2009 and $9.7 million in 2010. Conclusion: The financial impact of sorafenib to the provincial drug plans will range from $3.7 million to $9.7 million from 2008-2010.