PATIENT ASSISTANCE PROGRAMS - BC Cancer and for… · PATIENT ASSISTANCE PROGRAMS . Definitions...

PATIENT ASSISTANCE PROGRAMS Definitions BCCA BC Cancer Agency SAP Health Canada Special Access Program Class I Reimbursed for active cancer or approved treatment or approved indication only Class II 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

Restricted Funding Reimbursement for approved indications only. Completion of the BCCA 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.

If you are aware of Patient Assistance Programs updates that you would like to see added to this chart, please contact: [email protected] H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 1/32

mailto:[email protected]

http://www.bccancer.bc.ca/HPI/ChemotherapyProtocols/Forms.htm

Home injection programs DRUG SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Buserelin (SUPREFACT®)

Sanofi-Aventis Class I SUPREFACT® Home Injection Program Medicum Patient Assistance Program Tel: 1-877-787-3228 Fax: 1-877-787-3376 Assistance offered: • 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) Degarelix (FIRMAGON®)

Ferring Class I Coverdale Clinics - Firmagon® Injection Program Tel: 1-866-210-0399 Fax: 1-866-793-5500 Assistance offered: • Ten fully operational clinics across BC • Physician enrolls patient on the program for administration at a

nearby clinic. Goserelin (ZOLADEX®)

TerSera Class I ZOLADEX® Community Care and Home Injection Program Tel: 1-866-733-7511 Fax: 1-866-733-7514 Assistance offered: • Home Injection Program (free of charge)



DRUG SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Lanreotide (SOMATULINE®)

Ipsen Class I or Restricted Funding based on indication

IPSEN CARES Program Tel: 1-855-215-2288 Fax: 1-844-686-0661 Assistance offered: • Financial assistance is available to all patients with or without third

party insurance • Compassionate supply available, based on financial need • Home delivery service available • Home injection service (free of charge)

Leuprolide (ELIGARD®)

Sanofi-Aventis Class I ELIGARD® Home Injection Program Tel: 1-877-787-3228 Fax: 1-877-787-3376 Assistance offered: • Home delivery (waybills provided to pharmacies to ship leuprolide

and charge to the ELIGARD® Community Care and Home Injection Program)

• Home injection service (free of charge) Leuprolide (LUPRON®)

AbbVie Class I LupronCares Support Program Tel: 1-844-458-7766 Fax: 1-844-258-7766 Assistance offered: • Help for patients to obtain third party coverage • Financial assistance may be provided • Home injection service (free of charge) • Home delivery (pre-paid waybills provided to pharmacies to ship

leuprolide to patient’s home if they are immobile or live in rural areas)



DRUG SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Octreotide (SANDOSTATIN®)

Novartis Pharmaceuticals

Class I Access SANDOSTATIN® LAR Tel: 1-866-281-4688 Fax: 1-866-281-4689 Assistance offered: • Help for patients to obtain third party coverage • Financial assistance may be provided • Home injection service (free of charge)



Supportive care medications DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY

Aprepitant (EMEND®)

Merck Funded by BCCA for approved indications for BCCA inpatient use only.

Merck Canada Patient Assistance Program® Tel: 1-866-906-3725 Fax: 1-800-754-0151 Assistance offered: • 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

PharmaCare Special Authority required.

Dalteparin (FRAGMIN®)

Pfizer Funded by BCCA for approved indications for BCCA inpatient use only.

Fragmin® First Dose Program Tel: 1-800-563-3274 Fax: 1-855-874-9069 Assistance offered: • Sample card allows for:

o treatment doses (5 free syringes) o prophylactic doses (10 free syringes)

• Fragmin® Patient Assistance Card: o Financial assistance is available to all

patients who have third party insurance coverage but may need help with the co-pay




DRUG

SUPPLIER BCCA CLASS


Darbepoetin (ARANESP®)

Amgen Not funded by BCCA

VICTORY® Program Tel: 1-888-706-4717 Fax: 1-888-987-2201 Assistance offered: • Financial assistance is available to all patients

who have third party insurance coverage but may need help with the co-pay

• Darbepoetin will be shipped by Victory program to a designated pharmacy

• Program to be initiated before patient goes to pharmacy

Not required

Eltrombopag (REVOLADE®)

Novartis Not funded by BCCA

inReach Patient Support Program Tel: 1-888-475-4255 Fax: 1-888-475-3291 Assistance offered: • Financial assistance is available to patients with

or without third party insurance. Patients may be asked to co-pay based on household income.




DRUG

SUPPLIER BCCA CLASS


Epoetin Alfa (EPREX®)

Janssen Not funded by BCCA

SPECTRUM Support Program for Eprex® Tel: 1-877-793-7739 Fax: 1-888-298-8854 Assistance offered: • Financial assistance is available to all patients


• 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

Not required

Filgrastim (GRASTOFIL®)

Apotex Funded by BCCA for approved indications for inpatient use only.

Apobiologix® ANSWERS™ Patient Support Program Tel: 1-866-276-1664 Fax: 1-866-772-1458 www.apoanswers.ca Assistance offered: • Financial assistance is available to patients with

or without third party insurance coverage • Co-pay assistance available • Program needs to be initiated and PharmaCare

approval established before patient goes to the pharmacy




http://www.apoanswers.ca/

DRUG

SUPPLIER BCCA CLASS


Filgrastim (NEUPOGEN®)

Amgen Funded by BCCA for approved indications for inpatient use only.



• Victory® Program will assist with the co-pay based on financial need and Fair PharmaCare deductible for each patient

• Program needs to be initiated and PharmaCare approval established before patient goes to the pharmacy


Pegfilgrastim (NEULASTA®)




• 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 pharmacy

Not required



DRUG

SUPPLIER BCCA CLASS


Posaconazole (POSANOL®)

Merck Canada Not funded by BCCA

Merck Care® Oncology Tel: 1-877-494-0454 Fax: 1-877-656-0686 Assistance offered: • Financial assistance is available to eligible

patients with third party insurance coverage but may need help with the co-pay

• Compassionate supply available

Not required

Valacyclovir (VALTREX®)

GlaxoSmithKline Not funded by BCCA

VALTREX® Patient Assist Program Tel: 1-844-794-3577 Web: https://www.rxhelp.ca/Valtrex Assistance offered: • 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

Not required



https://www.rxhelp.ca/Valtrex

DRUG

SUPPLIER BCCA CLASS


Vorinostat (ZOLINZA®)

Merck Canada Not funded by BCCA

Merck Care® Oncology Tel: 1-877-494-0454 Fax: 1-877-656-0686 Assistance offered: • Financial assistance is available to eligible

patients with third party insurance coverage but may need help with the co-pay

• Compassionate supply available

Not required



Drugs with assistance/reimbursement programs and/or coordination of insurance coverage DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Abiraterone (ZYTIGA®)

Janssen Restricted Funding

Janssen BioAdvance® ZYTIGA® Drug Access and Patient Support Program Tel: 1-800-567-3331 Email: [email protected] Assistance offered: • Financial assistance is available to all patients with or without third

party insurance • No compassionate supply available • Home delivery available • Home delivery of one blood pressure monitor per patient available • Scheduling of monitoring services at a local clinic or patient’s home (if

applicable) Afatinib (GIOTRIF®)

Boehringer Ingelheim

Restricted Funding

HeadStart Patient Assistance Program Tel: 1-800-987-9080 Fax: 1-800-637-3515 Assistance offered: • Financial assistance is available to all patients with or without third

party insurance • Compassionate supply available • Home delivery available through HeadStart Program • Program information can be found at: www.BIHeadStart.ca

Alectinib (ALECENSARO®)

Roche Not funded by BCCA

Roche Patient Assistance Program (RPAP) Tel: 1-888-748-8926 Fax: 1-888-532-1198 Assistance offered: • Financial assistance is available to all patients with third party

insurance coverage but may need help with the co-pay



http://www.biheadstart.ca/

DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Alemtuzumab (CAMPATH®)

Genzyme Class I Clinigen Group Tel: +44 1283 494340 Fax: +44 1283 494341

Anastrozole (TEVA brand)

Teva Class I TEVA Compassionate Care Program Tel: 1-800-268-4129 Assistance offered: • Compassionate access is available to eligible patients • Application form is to be sent by mail or courier, and must be

accompanied by original prescription Atezolizumab (TECENTRIQ®)


Roche Patient Assistance Program (RPAP) Tel: 1-888-748-8926 Fax: 1-888-532-1198 Assistance offered: • This bridging program will provide financial assistance to eligible

patients, on a case-by-case basis Axitinib (INLYTA®)

Pfizer Restricted Funding

Pfizer Liaison Patient Support Program Tel: 1-844-616-6888 Fax: 1-844-636-6888 Assistance offered: • Financial assistance may be available on a case-by-case basis

Bevacizumab (AVASTIN®)

Roche Class I or Restricted Funding based on indication

Roche Patient Assistance Program (RPAP) Tel: 1-888-748-8926 Fax: 1-888-532-1198 Assistance offered: • Financial assistance is available to all patients with third party

insurance coverage but may need help with the co-pay • Infusion coordination provided if required



DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Bendamustine (TREANDA®)

Teva Restricted Funding

TREANDA® Patient Support Program Tel: 1-855-489-6576 Fax: 1-855-212-7875 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay • No compassionate supply available • Infusion coordination provided if required

Bosutinib (BOSULIF®)



Cabazitaxel (JEVTANA®)

Sanofi Restricted Funding

Sanofi Cancer Patient Assistance Program Tel: 1-855-5SANOFI Fax: 1-866-417-1945

Capecitabine (TEVA brand)

Teva Class I or Restricted Funding based on indication

TEVA Compassionate Care Program Tel: 1-800-268-4129 Assistance offered: • Compassionate access is available to eligible patients • Application form is to be sent by mail or courier, and must be

accompanied by original prescription



DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Carfilzomib (KYPROLIS®)


VICTORY® Program Tel: 1-888-706-4717 Fax: 1-888-987-2201 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with co-pay • Compassionate supply available

Ceritinib (ZYKADIA®)

Novartis Not funded by BCCA

My Lungs Program Tel: 1-855-489-4362 Fax: 1-855-788-3159 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay • 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 Cobimetinib (COTELLIC®)

Roche Restricted Funding

Roche Patient Assistance Program (RPAP) Tel: 1-888-748-8926 Fax: 1-888-532-1198 Assistance offered: • Financial assistance is available to all patients with or without third

party insurance • Bridging program ceases November 11, 2017



DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Crizotinib (XALKORI®)



Dabrafenib (TAFINLAR®)

GlaxoSmithKline Restricted Funding

inReach Patient Support Program Tel: 1-888-475-4255 Fax: 1-888-475-3291 Assistance offered: • Financial assistance is available to patients with or without third party

insurance. Patients may be asked to co-pay 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

Daratumumab (DARZALEX®)

Janssen Not funded by BCCA

Janssen BioAdvance® DARZALEX® Drug Access and Patient Support Program Tel: 1-800-567-3331 Email: [email protected] Assistance offered: • Financial assistance is available to patients with third party insurance • Some financial assistance may be available to patients without third

party insurance • No compassionate supply available • Private infusion clinic availability



DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Dasatinib (SPRYCEL®)

BMS Restricted Funding

Access to Hope Program Tel: 1-877-967-6626 Fax: 1-800-572-4971 Assistance offered: • Financial assistance and compassionate supply available to all patients

with or without third party insurance coverage on a case-by-case evaluation

Denosumab (XGEVA®)



insurance coverage but may need help with the co-pay Doxorubicin- pegylated liposomal (CAELYX®)

Janssen Class I Richard K. Plante, Director of Oncology, Janssen Tel: 416-382-5078 Mobile: 416-805-4648 e-mail: [email protected] or Myrna O’ Brodovich, Medical Information, Janssen Tel: 1-800-567-3331 e-mail: [email protected]

Durvalumab (IMFINZI®)

AstraZeneca Not funded by BCCA

AstraZeneca Oncology Patient Support Program Tel: 1-877-280-6208 Fax: 1-877-280-6221 Assistance offered: • Health Canada approved indication only • Financial assistance available based on financial need and availability of

third party insurance coverage • Coordination with private infusion clinic





DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Enzalutamide (XTANDI®)

Astellas Restricted Funding

XTANDI® Patient Assistance Program Tel: 1-855-982-6348 Fax: 1-855-982-6349 Assistance offered: • Financial assistance is available to all patients with or without third

party insurance • Home delivery available through McKesson Pharmacy

Eribulin (HALAVEN®)

Eisai Restricted Funding

Eisai Assistance Program Tel: 1-866-601-7340 Fax: 1-866-246-7195 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay • No compassionate supply available • Infusion coordination provided if required

Erlotinib (TARCEVA®)


Roche Patient Assistance Program (RPAP) Tel: 1-888-748-8926 Fax: 1-888-532-1198 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay • Financial assistance and RPAP services end March 31, 2015 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 www.innovicares.ca



DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Everolimus (AFINITOR®)

Novartis Class I or Restricted Funding based on indication

AfiniTRAC® Reimbursement Support Program Tel : 1-888-623-4648 Fax : 1-866-359-0175 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay Exemestane (TEVA brand)


accompanied by original prescription Fulvestrant (FASLODEX®)


Patient Assistance Program Tel: 1-877-280-6208 Fax: 1-877-280-6221 Email: [email protected] Assistance offered: • Compassionate supply available for eligible patients (non-visceral

metastatic ER+/HER2- without prior endocrine therapy) • Starting January 2018, new patients not meeting above criteria will be

eligible for up to 20% in financial assistance with the innoviCares benefit card, available at www.faslodexsupport.ca



http://www.faslodexsupport.ca/

DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Ibrutinib (IMBRUVICA®)


Janssen BioAdvance® IMBRUVICA® Drug Access and Patient Support Program Tel: 1-800-567-3331 Email: [email protected] Assistance offered: • Reimbursement portion of program closed to new enrollment after

December 29, 2017 o Patients already enrolled will continue to be supported o Reimbursement navigation/patient education will continue to

be available to all patients Idelalisib (ZYDELIG®)

Gilead Restricted Funding

Gilead Oncology Patient Support Program Tel: 1-844-453-6777 Fax: 1-844-663-6777 Assistance offered: • Financial assistance is available to patients with or without third party

insurance • Compassionate supply may be available

Imatinib (GLEEVEC®)

Novartis

Class I or Restricted Funding based on indication

GIST Alliance Tel: 1-855-489-4362 Fax: 1-855-788-3159 Assistance offered: • Program covers up to 20% of drug cost

Imatinib (TEVA brand)

Teva Class I or Restricted Funding based on indication

TEVA Compassionate Care Program Tel: 1-800-268-4129 Assistance offered: • Compassionate access is available to eligible patients • Application form is to be sent by mail or courier, and must be

accompanied by original prescription



DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Interferon alpha (INTRON A®)

Merck Class I Merck CareTM Oncology Tel: 1-877-494-0454 Fax: 1-877-656-0686 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay Ipilimumab (YERVOY®)

BMS Restricted Funding

ACCESS TO HOPE® Program Tel: 1-877-967-6626 Fax: 1-800-572-4971 Assistance offered: • 20% co-pay assistance available to all patients • Reimbursement navigation • Infusion clinic coordination

Irinotecan liposome (ONIVYDE®)

Baxalta / Shire Not funded by BCCA

onward patient support program Tel: 1-844-423-2090 Fax: 1-844-423-2060 Assistance offered: • Compassionate supply available

Ixazomib (NINLARO®)

Takeda Canada Not funded by BCCA

NINLARO® Compassionate Access Program Tel: 1-866-295-4636 Fax: 1-855-637-4745 Email: [email protected] Assistance offered: • Compassionate supply available on a case-by-case assessment • Tel/Fax/Email to obtain Compassionate Access Request Form.




DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Lapatinib (TYKERB®)


inReach® Patient Support Program Tel: 1-888-475-4255 Fax: 1-888-475-3291 Assistance offered: • Financial assistance is available to patients with or without third party

insurance. Patients may be asked to co-pay based on household income

Lenalidomide (REVLIMID®)

Celgene Restricted Funding

RevAid® program Tel: 1-888-738-2431 Fax: 1-877-585-2382 Web: www.revaid.ca Assistance offered: • Financial assistance is available to all patients with or without third

party insurance coverage • Compassionate supply may be available for non-BCCA funded

indications Lenvatinib (LENVIMA®)

Eisai Restricted Funding

EISAI CARES Patient Support Program Tel: 1-877-556-8785 Fax: 1-977-556-8695 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay Letrozole (FEMARA®)

Novartis Class I

Access FEMARA® Tel: 1-888-233-6272 Fax: 1-800-808-4964 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay • Compassionate supply of FEMARA® available based on financial need



http://www.revaid.ca/

DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Letrozole (TEVA brand)


accompanied by original prescription Nilotinib (TASIGNA®)

Novartis

Restricted Funding

The Alliance® Patient Support Program Tel: 1-855-489-4362 Fax: 1-855-788-3159 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay Nivolumab (OPDIVO®)

BMS Restricted Funding Not funded by BCCA

ACCESS TO HOPE® Program Tel: 1-877-967-6626 Fax: 1-800-572-4971 Assistance offered: • 20% co-pay assistance available to all patients (monotherapy) • Reimbursement navigation • Infusion clinic coordination _____________________________________________________________ Melody Program • Compassionate supply to be administered at BC Cancer centres

(combination therapy with BCCA-funded ipilimumab in treatment-naïve melanoma)

• Program enrolment ends December 31, 2018



DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Obinutuzumab (GAZYVA®)


Roche Patient Assistance Program (RPAP) Tel: 1-888-748-8926 Fax: 1-888-532-1198 Assistance offered: • Financial assistance is available to patients who have third party

insurance coverage but may need help with the co-pay, on a case-by-case basis

Olaparib (LYNPARZA®)

AstraZeneca

Not funded by BCCA

AstraZeneca Oncology Patient Support Program Tel: 1-877-280-6208 Fax: 1-877-280-6221 Assistance offered: • Compassionate supply available for patients without third party

insurance (Health Canada approved indication only) • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay Osimertinib (TAGRISSO®)


AstraZeneca Oncology Patient Support Program Tel: 1-877-280-6208 Fax: 1-877-280-6221 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay • Compassionate supply available



DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Paclitaxel-nab (ABRAXANE®)

Celgene Class I ABRAXANE® Access Program Tel: 1-844-234-2272 Fax: 1-844-253-2272 Assistance offered: • Financial assistance is available for non-BCCA funded indications

o For patients who have third party insurance coverage but may need help with the co-pay

o Reduced cost ‘Cash pay option’ for patients with no insurance coverage

• Compassionate supply NO LONGER AVAILABLE • Infusion coordination and/or shipping to private infusion clinic or

hospital pharmacy Palbociclib (IBRANCE®)

Pfizer Not funded by BCCA

Pfizer Liaison Patient Support Program Tel: 1-844-616-6888 Fax: 1-844-636-6888 Assistance offered:

• Financial assistance is available to eligible patients with third party insurance coverage who need help with the co-pay

• Compassionate supply is no longer available Panitumumab (VECTIBIX®)

Amgen Class I or Restricted Funding based on indication


insurance coverage but may need help with the co-pay • Financial assistance available to patients without third party insurance

coverage on a case-by-case evaluation



DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Pazopanib (VOTRIENT®)


inReach® Patient Support Program Tel: 1-888-475-4255 Fax: 1-888-475-3291 Assistance offered: • Financial assistance is available to patients with or without third party


Pembrolizumab (KEYTRUDA®)

Merck Canada Restricted Funding

MERCK CARE® Oncology Patient Assistance Program Tel: 1-855-549-9416 Fax: 1-855-549-9415 Assistance offered: • Enrolment criteria: Metastatic NSCLC with PD-L1 expression (≥50% by

validated test) with disease progression on or after platinum-containing chemotherapy. Patients with EGFR or ALK genomic tumor aberrations with disease progression on prior therapy.

• Financial assistance available to patients with or without third party insurance coverage. Patients may be asked to co-pay based on household income.

• Compassionate supply is available based on financial need • Infusion coordination for new patients provided at private infusion

clinics – Bayshore HealthCare. For locations in BC, see: www.bayshore.ca or email: [email protected]

Assistance offered to Healthcare professionals: • PD-L1 status determination is coordinated through the hospital/agency

laboratory or through MERCK CARE® Oncology Patient Assistance Program.



http://www.bayshore.ca/


DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Pemetrexed (ALIMTA®)

Lilly Class I or Restricted Funding based on indication

ALIMTA® Assistance with Reimbursement of Cost (ARC) Program Tel: 1-888-425-4682 Fax: 1-877-787-3376 Assistance offered: • 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 co-pay

o Compassionate supply may be available Pertuzumab (PERJETA®)



party insurance Pomalidomide (POMALYST®)




indications




DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Ponatinib (ICLUSIG®)

Paladin Restricted funding based on indication

ICLUSIG® Patient Support Program Tel: 1-844-425-8744 Fax: 1-844-425-8329 Assistance offered: • Coordination of third party insurance coverage

Ramucirumab (CYRAMZA®)

Lilly Restricted Funding

ENCIRCLE® Patient Support Program Tel: 1-855-545-5922 Fax: 1-844-503-7749 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay • Compassionate drug supply may be available • Program closed to new enrollment as of May 01, 2017

Regorafenib (STIVARGA®)

Bayer Restricted Funding

BTHER4U Patient Support Program Tel: 1-844-3THER4U Fax: 1-844-9THER4U Assistance offered: • Financial assistance available to all patients with or without third party

insurance coverage • Compassionate supply may be available

Rituximab (RITUXAN®)



insurance coverage but may need help with the co-pay • Infusion coordination provided if required



DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Romidepsin (ISTODAX®)


ISTODAX Access Program Tel: 1-844-234-2279 Fax: 1-844-253-2279 Assistance offered: • Financial assistance available on a case-by-case basis • Coordination of third party insurance coverage • No compassionate supply available

Romiplostim (NPLATE®)


eNable Support Program Tel: 1-888-675-2832 Fax: 1-888-675-2835 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay • No compassionate assistance available

Ruxolitinib (JAKAVI®)

Novartis Restricted Funding

The Alliance® Patient Support Program Tel : 1-855-489-4362 Fax : 1-855-788-3159 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay Siltuximab (SYLVANT®)


Janssen Compassionate Use Program Tel:1-800-387-8781 Fax: 1-844-592-2559 Email: [email protected] Assistance offered: • Compassionate supply available for those who qualify



tel:1-800-387-8781


DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Sorafenib (NEXAVAR®)

Bayer Restricted Funding

BTHER4U Patient Support Program Tel: 1-844-3THER4U Fax: 1-844-9THER4U Assistance offered: • Financial assistance available to all patients with or without third party

insurance coverage • Compassionate supply may be available

Sunitinib (SUTENT®)



Temozolomide (TEMODAL®)

Merck Class I Merck CareTM Oncology Tel: 1-877-494-0454 Fax: 1-877-656-0686 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay Temsirolimus (TORISEL®)





DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Thalidomide (THALOMID®)




indications Tocilizumab (ACTEMRA®)


JointEffort® program Tel: 1-888-748-8926 Fax: 1-888-532-1198 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay Trametinib (MEKINIST®)


inReach Patient Support Program Tel: 1-888-475-4255 Fax: 1-888-475-3291 Assistance offered: • Financial assistance is available to patients with or without third party


• Patient must be BRAF-positive • Program does not coordinate or cover cost of BRAF testing • Home delivery available through BioScript Pharmacy




DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Trastuzumab (HERCEPTIN®)



insurance coverage but may need help with the co-pay • Infusion coordination provided, if required

Trastuzumab Emtansine (KADCYLA®)



insurance coverage but may need help with the co-pay • Infusion coordination provided, if required

Vandetanib (CAPRELSA®)

Sanofi Genzyme Not funded by BCCA

CAPRELSA® Restricted Distribution Program Tel: 1-855-212-3922 Fax: 1-855-212-7871 Web: www.caprelsa.ca Assistance offered: • 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®)

• Financial assistance may be available to patients on a case-by-case basis

• Reimbursement guidance is available for patients with third party insurance coverage

• No compassionate supply available



http://www.caprelsa.ca/

DRUG

SUPPLIER BCCA CLASS

PROGRAM INFORMATION

Vemurafenib (ZELBORAF®)



party insurance • Bridging program ceases November 11, 2017

Venetoclax (VENCLEXTA®)

AbbVie Not funded by BCCA

AbbVie Care Program Tel : 1-844-346-6626 Fax : 1-844-684-6626 Assistance offered : • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay • Compassionate supply may be available

Vismodegib (ERIVEDGE®)


Roche Patient Assistance Program/ERIVEDGE® Pregnancy Prevention Program (RPAP/EPPP) Tel: 1-888-748-8926 Fax: 1-888-532-1198 Assistance offered: • Financial assistance is available to all patients who have third party

insurance coverage but may need help with the co-pay • Drug can only be dispensed to patients who are registered and meet all

conditions of the EPPP. For more information contact EPPP at 1-888-748-8926

Date updated: 01 Mar 2018 (updated: bendamustine, ibrutinib, nivolumab) Date created: 17 Oct 2008



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