Drugs are an important part of cancer treatment, yet patients often have difficulty accessing coverage for the most effective medicines.
The complexity of cancer drug coverage in Canada can overwhelm patients and families.

Oncology Drug Access Navigators of Ontario (ODANO) is a provincial organization founded to provide support, advocate for members, share resources and educate existing and new navigators in order to maximize the appropriate funding for all cancer patients. Our primary goal is to remove the financial burden from the patient so they can focus on their health. Because of the increasingly complex system to obtain drug coverage, the popularity of drug access navigators has grown, and ODANO now has more than 30 members.

Navigators act as resident experts on drug coverage and criteria for coverage. We facilitate drug coverage by (i) accessing government funding through programs such as the Exceptional Access Program (EAP) in Ontario, (ii) accessing compassionate use programs and (iii) finding other reimbursement programs for unfunded drugs. The EAP represents the bulk of our referrals given the paperwork involved, and it is very slow and inefficient. Particularly onerous is the EAP renewal process, which requires additional paperwork every three to six months. We also assist patients with their insurance forms and requests to drug companies for co-pay assistance.

Flaws in our current drug coverage system can lead to delays in treatment and result in negative health outcomes. For example, although cancer drugs administered in hospitals and clinics are often offered free of charge to patients, half of all new cancer drugs are taken at home and, therefore, many are not covered by the public health system.  Unfortunately, many of our patients do not have any private insurance. If a patient is fortunate enough to have private coverage, many drug plans require a 20% co-payment, which can quickly become a financial burden to our patients.

Drug access navigators work closely with pharmaceutical company representatives, who provide us with up-to-date information about their products’ coverage, including public and private coverage funding criteria and any company reimbursement programs.

To improve drug access, drug access navigators would like to see the following:

  • Health Canada’s approval process improved;
  • faster funding decisions by the payers;
  • fewer bureaucratic complexities in applying for access to cancer drugs;
  • fewer inequities in coverage of accepted standards of treatment between private and public plans; and
  • reduced time for prior authorizations and renewals; and a fast track system for the more urgent requests.

Paulette Birmingham is a drug access coordinator with the Sudbury Regional Cancer Centre.

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Back to more coverage from the 2011 Cancer Care Summit, hosted by Working Well.

Copyright © 2019 Transcontinental Media G.P. This article first appeared in Benefits Canada.

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