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
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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
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)
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 2/32
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)
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 3/32
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)
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 4/32
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
PharmaCare Special Authority required.
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 5/32
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.
PharmaCare Special Authority required.
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 6/32
SPECTRUM Support Program for Eprex® Tel: 1-877-793-7739 Fax: 1-888-298-8854 Assistance offered: • Financial assistance is available to all patients
who have third party insurance coverage but may need help with the co-pay
• 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
PharmaCare Special Authority required.
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 7/32
Amgen Funded by BCCA for approved indications for inpatient use only.
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
• 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
PharmaCare Special Authority required.
Pegfilgrastim (NEULASTA®)
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
• 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
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 8/32
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
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 9/32
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
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 10/32
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
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 11/32
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 Not funded by BCCA
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
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 12/32
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®)
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
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
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 13/32
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
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 14/32
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
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
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 15/32
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®)
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 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
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 16/32
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 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 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
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 17/32
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)
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 Fulvestrant (FASLODEX®)
AstraZeneca Not funded by BCCA
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
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 18/32
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
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 19/32
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.
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 20/32
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
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 21/32
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 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
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 22/32
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 Not funded by BCCA
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
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 23/32
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
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 • Financial assistance available to patients without third party insurance
coverage on a case-by-case evaluation
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 24/32
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
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.
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 25/32
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®)
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 Pomalidomide (POMALYST®)
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
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 26/32
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®)
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 who have third party
insurance coverage but may need help with the co-pay • Infusion coordination provided if required
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 27/32
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®)
Amgen Not funded by BCCA
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 Restricted Funding
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
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 28/32
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®)
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
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®)
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
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 29/32
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 Tocilizumab (ACTEMRA®)
Roche Not funded by BCCA
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®)
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
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 30/32
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 who have third party
insurance coverage but may need help with the co-pay • Infusion coordination provided, if required
Trastuzumab Emtansine (KADCYLA®)
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 who have third party
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
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 31/32
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
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 Restricted Funding
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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