PATIENT ASSISTANCE PROGRAMS

Transcription

1 PATIENT ASSISTANCE PROGRAMS Definitions SAP Class I Class II BC Cancer Agency Health Canada Special Access Program Reimbursed for active cancer or approved treatment or approved indication only Reimbursed for approved indications only. Completion of Class II Approval Form is necessary. In addition, where indicated, approval from Tumour Group Chair or delegate is required for reimbursement Reimbursement for approved indications only. Completion of the Compassionate Access Program Application (formerly Undesignated Indication Form) is necessary to provide the appropriate clinical information for each patient The Patient Assistance Program chart is a general reference on the available programs offered by pharmaceutical manufacturers to help patients access specific drug therapies. Inclusion in the chart does not imply BC Cancer Agency endorsement of any drug therapy that is not approved on the BC Cancer Agency Benefit Drug List. Care has been taken to ensure accuracy of information; however it is not intended to replace specific information as provided by the manufacturer. Since program requirements are constantly evolving, it is advised that this chart not be used as a sole source of information. Home injection programs DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Buserelin (SUPREFACT ) Sanofi-Aventis Class I SUPREFACT Home Injection Program Medicum Patient Assistance Program Tel: Fax: Home delivery (weigh bills provided to pharmacies to ship buserelin and charge to the SUPREFACT Community Care and Home Injection Program) Home injection service (free of charge) 1/20

2 Goserelin (ZOLADEX ) Leuprolide (ELIGARD ) Leuprolide (LUPRON ) DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Degarelix (FIRMAGON ) Ferring Class I FIRMAGON Care Program Tel: Fax: Home delivery (weigh bills provided to pharmacies to ship degarelix and charge to the FIRMAGON Care Program) Home injection service (free of charge) for nonambulatory patients near major centers (caseby-case basis in remote regions) Astra-Zeneca Class I ZOLADEX Community Care and Home Injection Program Tel: Fax: Home delivery (weigh bills provided to pharmacies to ship goserelin and charge to the ZOLADEX Community Care and Home Injection Program) free of charge Sanofi-Aventis Class I ELIGARD Home Injection Program Tel: Fax: TAP Pharmaceuticals Class I Home delivery (weigh bills provided to pharmacies to ship leuprolide and charge to the ELIGARD Community Care and Home Injection Program) Home injection service (free of charge) LUPRON Comfort Program Tel: Fax: Help for patients to obtain third party coverage Financial assistance may be provided Home injection service (free of charge) 2/20

3 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Octreotide (SANDOSTATIN ) Novartis Pharmaceuticals Class I Access SANDOSTATIN LAR Tel: Fax: Help for patients to obtain third party coverage Financial assistance may be provided Home injection service (free of charge) 3/20

4 Supportive care medications DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Aprepitant (EMEND ) Merck PharmaCare Special Authority required. Dalteparin (FRAGMIN ) Darbepoetin (ARANESP ) Pfizer Amgen Funded by for approved indications for inpatient use only. Funded by for approved indications for inpatient use only. Merck Canada Patient Assistance Program Tel: Fax: Compassionate supply is available to patients without third party insurance coverage Once certain criteria are met (i.e. proof of low income) medication is delivered to prescriber s office or to a designated pharmacy to dispense and for patient pick up Fragmin SmartSample Program Tel: Once prescribed by the physician, the physician will: o Apply for PharmaCare Special Authority o Give the patient a SmartSample card The SmartSample card entitles the patient to a few free dalteparin pre-filled syringes from a community pharmacy for use while waiting for PharmaCare approval o o VICTORY Program Tel: Fax: treatment doses (5 free syringes) prophylactic doses (10 free syringes) Financial assistance is available to all patients who have third party insurance coverage but may need help with the Darbepoetin will be shipped by Victory program to a designated pharmacy Program to be initiated before patient goes to pharmacy Please fax form General Special Authority Request to PharmaCare Fax: PharmaCare Special Authority required. Please fax form Venous Thromboembolic Disease to PharmaCare Fax: /20

5 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Eltrombopag (REVOLADE ) GlaxoSmithKline inreach Patient Support Program Tel: Fax: Financial assistance is available to patients with or without third party insurance. Patients may be asked to based on household income. Epoetin Alfa (EPREX ) Filgrastim (NEUPOGEN ) Janssen Amgen Funded by for approved indications for inpatient use only. SPECTRUM Support Program for Eprex Tel: Fax: Financial assistance is available to all patients who have third party insurance coverage but may need help with the A compassionate supply is available to patients without third party insurance coverage, based on financial needs SPECTRUM program coordinates delivery with patients preferred pharmacy Initial self injection training with Nurse available in most regions. SPECTRUM program will coordinate nurse home visit with patient VICTORY Program Tel: Fax: Financial assistance is available to all patients who have third party insurance coverage but may need help with the Victory Program will assist with the based on financial need and Fair PharmaCare deductible for each patient Compassionate supply will be shipped by Victory program to a designated pharmacy. Program to be initiated and PharmaCare approval established before patient goes to the pharmacy PharmaCare Special Authority required prior to program being initiated. Please fax form Filgrastim (GCSF) to PharmaCare Fax: /20

6 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Pegfilgrastim (NEULASTA ) Amgen VICTORY Program Tel: Fax: Financial assistance is available to all patients who have third party insurance coverage but may need help with the Compassionate supply will be shipped by Victory program to a designated pharmacy If patient is prescribed NEULASTA and has no third party coverage, they will be offered NEUPOGEN Program to be initiated before patient goes to Valacyclovir (VALTREX ) GlaxoSmithKline pharmacy VALTREX Patient Assist Program Tel: Web: The VALTREX Patient Assist Program will cover up to the difference between the out of pocket amount of branded VALTREX (valacyclovir hydrochloride) versus the out of pocket amount a patient would have paid based on the average generic drug price. This amount will vary depending on each patient s coverage (i.e., public, private, none) in each province. Patients must first have their prescription filled at a community pharmacy and have the receipt when they call the program 6/20

7 Drugs with assistance/reimbursement programs and/or coordination of insurance coverage DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Abiraterone (ZYTIGA ) Afatinib (GIOTRIF ) Axitinib (INLYTA ) Janssen Boehringer Ingelheim Pfizer ZYTIGA Access Program (ZAP) Tel: Fax: Financial assistance is available to all patients with or without third party insurance No compassionate supply available Home delivery available through McKesson Pharmacy Home delivery of one blood pressure monitor per patient available HeadStart Patient Assistance Program Tel: Fax: Financial assistance is available to all patients with or without third party insurance Compassionate supply available Home delivery available through BioScript Pharmacy Program information can be found at: Pfizer Oncology Reimbursement Assistance Program - Inlyta Tel: Fax: Financial assistance is available to eligible patients with 7/20

8 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Bevacizumab (AVASTIN ) Bendamustine (TREANDA ) Bosutinib (BOSULIF ) Capecitabine (XELODA ) Roche Lundbeck Pfizer Roche Class II or based on indication Class II or based on indication Roche Patient Assistance Program Tel: Fax: Financial assistance is available to all patients with third party insurance coverage but may need help with the copay Infusion coordination provided if required TREANDA Patient Support Program Tel: Fax: No compassionate supply available Infusion coordination provided if required BOSULIF First Resource Program Tel: Fax: Financial assistance is available to patients with or without third party insurance Compassionate supply may be available Assistance offered until September 3, 2015 Roche Patient Assistance Program Tel: Fax: /20

9 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Ceritinib (ZYKADIA ) Crizotinib (XALKORI ) Dabrafenib (TAFINLAR ) Novartis Pfizer GlaxoSmithKline My Lungs Program Tel: Fax: Patients who were previously enrolled in the compassionate use program will get financial assistance with no limit. New patients will get 20% financial assistance. Home delivery available through McKesson Pharmacy XALKORI Reimbursement Support Program First Resource Program (Medicum) Tel: Fax: Crizotinib will only be provided to patients who have tested ALK-positive using a validated ALK assay at a laboratory with demonstrated proficiency in the specific technology Program does not coordinate or cover cost of ALK testing inreach Patient Support Program Tel: Fax: Financial assistance is available to patients with or without third party insurance. Patients may be asked to based on household income. Patient must be BRAF-positive Program does not coordinate or cover cost of BRAF testing Home delivery available through BioScript Pharmacy 9/20

10 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Denosumab (XGEVA ) Doxorubicinpegylated liposomal (CAELYX ) Amgen VICTORY Program Tel: Fax: Janssen Class II Richard K. Plante, Director of Oncology, Janssen Tel: Mobile: rplante@its.jnj.com Enzalutamide (XTANDI ) Eribulin (HALAVEN ) Astellas Eisai or Myrna O Brodovich, Medical Information, Janssen Tel: medinfocanada@joica.jnj.com XTANDI Patient Assistance Program Tel: Fax: Financial assistance is available to all patients with or without third party insurance Home delivery available through McKesson Pharmacy Eisai Assistance Program Tel: Fax: No compassionate supply available Infusion coordination provided if required 10/20

11 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Erlotinib (TARCEVA ) Roche Class II or based on indication Roche Patient Assistance Program Tel: Fax: Financial assistance and RPAP services end March 31, 2015 Everolimus (AFINITOR ) Novartis Class II or based on indication InnoviCares - Tarceva benefit card: Program covers up to the difference in the drug ingredient cost between Tarceva and the respective generic alternatives Benefit card can be downloaded from AfiniTRAC Reimbursement Support Program Tel : Fax : /20

12 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Fulvestrant (FASLODEX ) Ibrutinib (IMBRUVICA ) Idelalisib (ZYDELIG ) AstraZeneca Janssen Gilead FasloCARE Program Tel: Fax: Financial assistance is available to patients with or without third party insurance Compassionate supply may be available InnoviCares - Faslodex benefit card: Program covers up to 20% of Faslodex prescription Benefit card can be downloaded from Faslodex Injection Support Program (FISP) Tel: Fax: Faslodex@innomar-strategies.com Offering injection services for patients with drug supply Imbruvica YOU&i TM Patient Support program Tel: Fax: Financial assistance is available to all patients who have third party insurance coverage but may need help with the Compassionate drug access will end on 30 June 2015 Home delivery available through McKesson Pharmacy Gilead Oncology Patient Support Program Tel: Fax: Financial assistance is available to patients with or without third party insurance Compassionate supply may be available 12/20

13 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Imatinib (GLEEVEC ) Interferon alpha (INTRON A ) Ipilimumab (YERVOY ) Lapatinib (TYKERB ) Novartis Class II GIST Alliance Tel: Fax: Merck Class I Merck Care TM Oncology Tel: Fax: Bristol-Myers Squibb GlaxoSmithKline Program covers up to 20% of drug cost YERVOY Access to Hope Program Tel: Fax: Enrolment criteria: not for off-label indications Financial assistance and compassionate supply available to all patients with or without third party insurance coverage on a case-by-case evaluation Prescribers must complete a certification program prior to prescribing the drug via inreach Patient Support Program Tel: Fax: Financial assistance is available to patients with or without third party insurance. Patients may be asked to based on household income 13/20

14 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Lenalidomide (REVLIMID ) Letrozole (FEMARA ) Nilotinib (TASIGNA ) Pazopanib (VOTRIENT ) Celgene Novartis Pharmaceuticals Novartis GlaxoSmithKline Class I RevAid program Tel: Fax: Website: Compassionate supply may be available for non- funded indications Access FEMARA Tel: Fax: Compassionate supply of FEMARA available based on financial need GIST Alliance Tel: Fax: Program covers up to 20% of drug cost inreach Patient Support Program Tel: Fax: Financial assistance is available to patients with or without third party insurance. Patients may be asked to based on household income 14/20

15 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Pembrolizumab (KEYTRUDA ) Pemetrexed (ALIMTA ) Merck Canada Lilly Class II or based on indication MERCK CARE Oncology Patient Assistance Program Tel: Fax: Enrolment criteria: Patients with unresectable or metastatic melanoma and disease progression following ipilimumab therapy and, if BRAF V600 mutation positive, following a BRAF or MEK inhibitor as per proposed indication. Financial assistance available to patients with or without third party insurance coverage. Patients may be asked to based on household income Compassionate supply is available based on financial needs Patients previously enrolled in the compassionate use program will continue to receive supply for the duration of therapy Infusion coordination for new patients provided at private infusion clinics Bayshore HealthCare. For locations in BC, see: or keytruda@bayshore.ca ALIMTA Assistance with Reimbursement of Cost (ARC) Program Tel: Fax: Coordination of third party insurance coverage, including WorkSafeBC Based on financial need: o Financial assistance may be available to patients who have third party insurance coverage but may need help with the o Compassionate supply may be available 15/20

16 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Pertuzumab (PERJETA ) Pomalidomide (POMALYST ) Regorafenib (STIVARGA ) Roche Celgene Bayer Roche Patient Assistance Program (RPAP)- Perjeta Tel: Fax: Pomalyst Access Program Tel: Fax: Program opens for enrolment until March 31, 2015 Enrolment criteria: failed Bortezomib and Lenalidomide Financial assistance is available to all patients with or without third party insurance coverage Compassionate drug supply may be available ABC STIVARGA program Tel: Fax: Financial assistance available to all patients with or without third party insurance coverage Program covers up to 20% of drug cost 16/20

17 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Romidepsin (ISTODAX ) Rituximab (RITUXAN ) Romiplostim (NPLATE ) Celgene Roche Amgen Class II or based on indication ISTODAX Access Program Tel: Fax: Program opens for enrolment until March 31, 2015 Compassionate supply available to patients enrolled prior to March 31, 2014 Enrolment criteria: relapsed/refractory Peripheral T-Cell Lymphoma (PTCL) not eligible for stem cell transplant; failed at least one prior systemic therapy Financial assistance available to all patients with or without third party insurance coverage No infusion cost assistance Roche Patient Assistance Program Tel: Fax: Infusion coordination provided if required enable Support Program Tel: Fax: No compassionate assistance available 17/20

18 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Ruxolitinib (JAKAVI ) Sorafenib (NEXAVAR ) Temozolomide (TEMODAL ) Thalidomide (THALOMID ) Tocilizumab (ACTEMRA ) Novartis Bayer Novartis Alliance Program- MPN Alliance Tel : Fax : Merck Class II Merck Care TM Oncology Tel: Fax: Celgene Roche Assistance Bayer Canada (ABC) NEXAVAR Program Tel: Fax: RevAid program Tel: Fax: Website: Compassionate supply may be available for non- funded indications JointEffort program Tel: Fax: /20

19 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Trametinib (Mekinist ) Trastuzumab (HERCEPTIN ) Trastuzumab Emtansine (KADCYLA ) GlaxoSmithKline Roche Roche Class II or based on indication inreach Patient Support Program Tel: Fax: Financial assistance is available to patients with or without third party insurance. Patients may be asked to based on household income Patient must be BRAF-positive Program does not coordinate or cover cost of BRAF testing Home delivery available through BioScript Pharmacy Roche Patient Assistance Program Tel: Fax: Infusion coordination provided, if required Roche Patient Assistance Program (RPAP)- Kadcyla Tel: Fax: Infusion coordination provided, if required 19/20

20 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE Vandetanib (CAPRELSA ) Vemurafenib (ZELBORAF ) Vismodegib (ERIVEDGE ) AstraZeneca Roche Roche CAPRELSA Distribution Program Tel: Website: Prescribing physicians and pharmacists need to complete a certification process and register with the program in order to enrol patients, prescribe and dispense vandetanib (CAPRELSA ). No compassionate supply of vandetanib offered by program Reimbursement guidance for patients with third party insurance coverage offered by Shoppers Drug Mart Specialty Health Network. Tel: See: Drugs with Special Ordering Procedures (SAP chart) Roche Patient Assistance Program (RPAP) Tel: Fax: Financial assistance is available to all patients with or without third party insurance Roche Patient Assistance Program/ERIVEDGE Pregnancy Prevention Program (RPAP/EPPP) Tel: Fax: Drug can only be dispensed to patients who are registered and meet all conditions of the EPPP. For more information contact EPPP at /20