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ODANO
Oncology Drug Access Navigators of Ontario
1
Objectives
• Who is ODANO?
• Backgrounds
• Regions
• Our referral process – why this role is needed
• Benefits to the patient
• Benefits to the Centre
• How we work together
2
Objectives
• Challenges / Wish list
• Public coverage
• Private coverage
• Case studies
3
ODANO – Oncology Drug Access
Navigators of Ontario
ODANO is a provincial organization of Drug
Access Navigators founded to provide
support, advocate for members, educate and
share resources with existing and new
members in order to maximize the
appropriate funding for all oncology patients.
4
Mission Statement - ODANO
Every ODANO member has the resources and
the knowledge to ensure that every oncology
patient has access to the medication they need.
5
Backgrounds
Currently our membership is over 50 members
 Pharmacy technicians
 Administrative Assistants
 SocialWorkers
 RN’s
 Pharmacists
6
List of Cities – sample
 Barrie
 Grand River
 Hamilton
 Kingston
 Lakeridge
 London
 Markham
 Niagara Falls
 NorthYork
 Ottawa
 Peterborough
 Sarnia
 Sault Ste Marie
 Scarborough
 Sudbury
 Sunnybrook
 Thunder Bay
 Toronto
 Windsor
7
Navigators other Provinces
 Alberta
 British Columbia
 Quebec
 New Brunswick
 Newfoundland
 Nova Scotia
8
Our Referrals - Defined
 If a patient has no drug coverage we will assist
with theTrillium Application
 Annual Deductibles are based on Household Net
Income
 Divided into quarters
 Approximately 4-5% of net
 Apply -Track and Renew MOH - Exceptional
Access Programs applications
 Drugs that are not listed as General Benefit and/or Ltd
use with the ODB
9
Our Referrals - Defined
 Apply to the Special Access Program – Health
Canada
 For drugs that have not yet received NOC – Notice
of Compliance
 Not funded by the Province
 Help patient find $ for treatment
10
Our Referrals - Defined
 Investigate funding through Private
Insurance Carriers
 3 way calls between the patient – Insurance
Company and Navigator
 Prior Authorization Forms
 Exceptions to the formulary
 Renewals are required every 6 – 12 months for
many drugs
 Appeals
11
Our Referrals - Defined
 Sometimes we have to use a combination of
Private and Public plans to fully fund the drug
 Enroll patients with Pharmaceutical Company
Patient Assistance Programs to investigate
what kind of programs are available to help
patients
12
Benefits to the patient
 We are : Patient advocates
 Remove the financial burden from the patient
 Reduce the patients / families anxiety
 Assist patients to access coverage
 Explore all possibilities
 Assist patients with their insurance forms
13
Benefits to the Institution
 Centralized program
 One stop shopping
 Resident expert
 investigate
 Part of the treatment team
14
Treatment Team
Physician
Drug Navigator
Nurse
PharmacistSocial Worker
Patient
15
How we work together
 Physician makes a referral to Drug Access
 He/she will ask us to investigate various
treatment options
 The Physician makes the final decision on
what treatment will be used
16
Public Payer Issues - Wish
List
 Quicker processing of applications by theTrillium
Drug Program
 Can take 6+ weeks
 Delays in treatment
 Can affect treatment outcomes
 Quicker response time by the MOH -Exceptional
Access Program
 Currently applications are taking 4+ weeks
 Should be 1-2 weeks
17
Private Payer Issues – Wish
List
1. Private payers deal directly with the DAN on
behalf of patient
 Today most carriers will not speak with the DAN
without having to have the patient on the line.
 Recognized as a member of the patient’s health
care team and patient’s advocate
 Dedicated contact or team that we could deal
with directly with the insurance carrier
18
Private Payer Issues – Wish
List
2. Would like to see quicker decisions (5
business days)
 Because these are cancer treatments, they can
be a matter of life and death
 Sometimes take up to 10 days (almost two
weeks) to get a response
19
Private Payer Issues – Wish
List
3. Dedicated management contact to escalate
issues if necessary.
 When DAN’s are given incorrect information or
the case has to be escalated with the payer
organization.
 Difficult to be transferred to a supervisor by the
call centre representatives.
20
21
CASE STUDIES
Case Study #1
 Newly diagnosed breast cancer
 She has private insurance
 Will receive 8 cycles of adjuvant IV
chemotherapy
 Requires supportive medications
at a cost of $19k – duration of treatment
 Referral is made to DAN
22
 Investigation into her private plan
 Drugs are covered at 100%
 Plan has an Annual Maximum of $5000
 Pay direct card
That’s only adequate coverage for less than
1/3 of the cost of the medications she’ll
require
23
 Max out her private plan
 Assist patient withTrillium Application
 Arrange to have application expedited
 Transition from Private Insurance toTrillium
(Public)
Adequate funding has been secured for all
of the medication required at little cost to
the patient
24
Case study #2
 Patient has been prescribed an oral
chemotherapy treatment
 Cost is $4k / month
 Referral made to DAN
Action Plan
 Investigate - private insurance
 Covered at 100%
 Patient has a pay and submit plan
 Patient has no means to pay
25
 DAN ask the Insurance company if they can
make an exception
 Application is denied
 Contact the Pharmaceutical Company Patient
Assistance Program to investigate what
programs are available to help patients
 They offer “An Agreement to Pay”
 Our request is accepted
The patient can proceed with the treatment
26
Case Study #3
 Patient with disease progression is referred
 Patient has private insurance
 The medication is not a benefit under his plan
 Make an application to the Insurance
company for an Exception to the formulary
 Application is denied
27
 The drug is NOT publicly funded
 Only available to patients with private
insurance
 No other treatment options for this patient
Patient continues to be followed by the
Oncologist without treatment…
28
Summarize
• Who is ODANO?
• Backgrounds
• Regions
• Our referral process – why this role is needed
• Benefits to the patient
• Benefits to the Centre
• How we work together
• Challenges / Wish list
• Public coverage
• Private coverage
29
Canadian Cancer
Survivor Network
Biography
 Michele MacDonald
 Drug Access Facilitator
 Juravinski Cancer Centre
 Hamilton, Ontario
 Treasure of Oncology Drug Access Navigators of
Ontario (ODAN) O
 Has worked at the Juravinski Cancer Centre since
October 2007. She started her career in pharmacy
working at Shoppers Drug Mart while going to Mohawk
College pursuing the pharmacy technician diploma.
 After finishing school while still working at Shoppers a
job was offered working at the Juravinski Cancer Centre
mixing chemotherapy which she continued until 2008
when the drug access job came available.
 Michele has also worked at Mohawk College as a teaching
assistant in the sterile IV lab course.
 Duly licensed as a member of the College of Pharmacists
and entitle to practice as a Pharmacy Technician.
 Member of the Ontario Pharmacists Association.
 Registered with the Pharmacy Examining Board of
Ontario
 Treasure for Oncology Drug Access navigators of
Ontario (ODAN) O
Cancer
 I was diagnosed with breast cancer on November 4th, 2013. I
will never forget the day I heard that news. I was numb,
shocked, afraid, and devastated.
 How can this be happening to me? It happens to other people
not me? In a matter of days my life turned into a complete
roller coaster of doctors appointments, ultrasounds, X-rays,
MRI, and no more work.
 I didn’t have time to process what was happening and I was
leaving in 2 days for Cuba. Do I go? I did as I figured it was
better to wait for results from the biopsy in the sun then to
stew about it at home in the cold.
Cancer
 C – Courage, Courageous
 A – Advocate
 N - Never give up
 C – Celebrate Life
 E – Enthusiastic
 R - Research
My Journey
 The last year and a half has been just a blur, one thing after another. I
remember thinking this will be easy I work here, I know what’s going to
happen, and it will be fine!! Boy was I wrong I had no idea what I was in for.
You have no idea until your on the other side.
 First there was the biopsy results, positive for invasive ductal carcinoma. I was
blessed at that point that I was given an appointment with the surgical
oncologist the next week. A bilateral mastectomy came next and I was
definitely not prepared for that. Next came 4 months of chemotherapy as 3
out of the 6 lymph nodes came back with microscopic cells. All I could think
about was Oh gosh I’m going to lose my hair!!, not the fact that within weeks
I would have toxic drugs running through my veins. Next came the Axillary
Node dissection, a procedure in which the next level of lymph nodes are
removed. Negative, whew what a relief. Finally some good news for a change.
Radiation followed everyday for 6 weeks, I really found out how much I did
not know. I was exhausted mentally and physically.
 During the whole journey I was also seeing the plastic surgeon who put
chest expanders in at the same time as my mastectomy so that I could go
through the expansion process. This process includes going to see the
doctor every 2 weeks so that he can inject saline into the expanders to
gently expand the remaining skin to make room for implants. This
unfortunately did not go well. Due to the tissue damage from radiation
my skin would not stretch and was incredibly painful. The decision was
made for me to undergo a 3rd surgery called a Latissimus Dorsi Flap
surgery. This entails removing tissue, muscle and skin from your back
and adding onto your front breast area in order to make room for
expansion. This was by far my greatest challenge, I was in quite a lot of
pain and came home with 3 drains. Homecare nurses would come every
2nd day to check on the incision and drainage.
 3 weeks after this last surgery I returned to seeing the plastic
surgeon for saline injections into the chest expanders. I am
totally relieved that now my skin is stretching out wonderfully
and once I get to the desired breast size I wish to be the
injections stop.
 2 months later I will finally get the implants, we are hoping for
July or August, then I get to go back to work. It will almost be
2 full years that I have been off work.
Drug Access
 Working as a drug access navigator my first concern was
what is going to be the drug costs?
 I was extremely lucky my husbands coverage was 100%
with no co-pays or prior authorization forms
 I counted my blessings that this would not be a worry.
 When treatment was completed I was shocked at the total
amount of prescription costs.
 Drug access navigators are definitely a necessity.
What have I learned?
 Breast Cancer is the 2nd leading cause of death in Canada.
 Breast Cancer death rates have gone down in every age
group. This reflects the impact of screening and better
treatment options.
 No one is safe from this disease!! If it happened to me it
can happen to you
 Cancer does not discriminate.
Working in Health Care
 Working as a drug access facilitator and going through cancer
myself will allow me to be able to do my job better when I
return to work. I have always tried to look normal, do my
make-up, dress nice, and have a smile on my face. Even though
I felt terrible, it didn’t mean I was fine. I will definitely have
more patience for people because you never know what may be
going on with them.
 My co-workers were the best. It was a very heartwarming
experience to see how much I was cared for. Not one chemo
session went by where I didn’t have the staff coming to cheer
me up. Working in the environment that we do certainly does
make the journey go easier but it is still overwhelming.
Final Thoughts
 I came from a pretty close family, but it definitely made us
closer as a whole and really makes you enjoy every minute
you have.
 Ask for help. Don’t wait for offers. Other people can
cook for you, clean for you, do laundry, errands or
banking. Only you can fight the cancer!!!
 I learned that I can put myself first, this is the first time in
my life that I can honestly say I learned to do that.
 Focus on the present and use your energy to focus on
treatment and getting better. Dwelling on what you can’t
change will only cause you to lose the ability to cope.
 You can sit and cry or feel sorry for yourself, or you can
choose to be strong and positive. Trust me, it will make
you stronger, more positive and change your outlook on
life. In some ways, cancer was a good thing for me. A
perfectionist who now can slow down, relax, and enjoy
life.
44
QUESTIONS…
Canadian Cancer Survivor Network
Contact Info
Canadian Cancer Survivor Network
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2C 2B5
Telephone / Téléphone : 613-898-1871
E-mail jmanthorne@survivornet.ca or mforrest@survivornet.ca
Web site www.survivornet.ca
Blog: http://jackiemanthornescancerblog.blogspot.com/
Twitter: @survivornetca
Facebook: www.facebook.com/CanadianSurvivorNet
Pinterest: http://pinterest.com/survivornetwork/

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Canadian Cancer Survivor Shares Inspiring Journey

  • 1. ODANO Oncology Drug Access Navigators of Ontario 1
  • 2. Objectives • Who is ODANO? • Backgrounds • Regions • Our referral process – why this role is needed • Benefits to the patient • Benefits to the Centre • How we work together 2
  • 3. Objectives • Challenges / Wish list • Public coverage • Private coverage • Case studies 3
  • 4. ODANO – Oncology Drug Access Navigators of Ontario ODANO is a provincial organization of Drug Access Navigators founded to provide support, advocate for members, educate and share resources with existing and new members in order to maximize the appropriate funding for all oncology patients. 4
  • 5. Mission Statement - ODANO Every ODANO member has the resources and the knowledge to ensure that every oncology patient has access to the medication they need. 5
  • 6. Backgrounds Currently our membership is over 50 members  Pharmacy technicians  Administrative Assistants  SocialWorkers  RN’s  Pharmacists 6
  • 7. List of Cities – sample  Barrie  Grand River  Hamilton  Kingston  Lakeridge  London  Markham  Niagara Falls  NorthYork  Ottawa  Peterborough  Sarnia  Sault Ste Marie  Scarborough  Sudbury  Sunnybrook  Thunder Bay  Toronto  Windsor 7
  • 8. Navigators other Provinces  Alberta  British Columbia  Quebec  New Brunswick  Newfoundland  Nova Scotia 8
  • 9. Our Referrals - Defined  If a patient has no drug coverage we will assist with theTrillium Application  Annual Deductibles are based on Household Net Income  Divided into quarters  Approximately 4-5% of net  Apply -Track and Renew MOH - Exceptional Access Programs applications  Drugs that are not listed as General Benefit and/or Ltd use with the ODB 9
  • 10. Our Referrals - Defined  Apply to the Special Access Program – Health Canada  For drugs that have not yet received NOC – Notice of Compliance  Not funded by the Province  Help patient find $ for treatment 10
  • 11. Our Referrals - Defined  Investigate funding through Private Insurance Carriers  3 way calls between the patient – Insurance Company and Navigator  Prior Authorization Forms  Exceptions to the formulary  Renewals are required every 6 – 12 months for many drugs  Appeals 11
  • 12. Our Referrals - Defined  Sometimes we have to use a combination of Private and Public plans to fully fund the drug  Enroll patients with Pharmaceutical Company Patient Assistance Programs to investigate what kind of programs are available to help patients 12
  • 13. Benefits to the patient  We are : Patient advocates  Remove the financial burden from the patient  Reduce the patients / families anxiety  Assist patients to access coverage  Explore all possibilities  Assist patients with their insurance forms 13
  • 14. Benefits to the Institution  Centralized program  One stop shopping  Resident expert  investigate  Part of the treatment team 14
  • 16. How we work together  Physician makes a referral to Drug Access  He/she will ask us to investigate various treatment options  The Physician makes the final decision on what treatment will be used 16
  • 17. Public Payer Issues - Wish List  Quicker processing of applications by theTrillium Drug Program  Can take 6+ weeks  Delays in treatment  Can affect treatment outcomes  Quicker response time by the MOH -Exceptional Access Program  Currently applications are taking 4+ weeks  Should be 1-2 weeks 17
  • 18. Private Payer Issues – Wish List 1. Private payers deal directly with the DAN on behalf of patient  Today most carriers will not speak with the DAN without having to have the patient on the line.  Recognized as a member of the patient’s health care team and patient’s advocate  Dedicated contact or team that we could deal with directly with the insurance carrier 18
  • 19. Private Payer Issues – Wish List 2. Would like to see quicker decisions (5 business days)  Because these are cancer treatments, they can be a matter of life and death  Sometimes take up to 10 days (almost two weeks) to get a response 19
  • 20. Private Payer Issues – Wish List 3. Dedicated management contact to escalate issues if necessary.  When DAN’s are given incorrect information or the case has to be escalated with the payer organization.  Difficult to be transferred to a supervisor by the call centre representatives. 20
  • 22. Case Study #1  Newly diagnosed breast cancer  She has private insurance  Will receive 8 cycles of adjuvant IV chemotherapy  Requires supportive medications at a cost of $19k – duration of treatment  Referral is made to DAN 22
  • 23.  Investigation into her private plan  Drugs are covered at 100%  Plan has an Annual Maximum of $5000  Pay direct card That’s only adequate coverage for less than 1/3 of the cost of the medications she’ll require 23
  • 24.  Max out her private plan  Assist patient withTrillium Application  Arrange to have application expedited  Transition from Private Insurance toTrillium (Public) Adequate funding has been secured for all of the medication required at little cost to the patient 24
  • 25. Case study #2  Patient has been prescribed an oral chemotherapy treatment  Cost is $4k / month  Referral made to DAN Action Plan  Investigate - private insurance  Covered at 100%  Patient has a pay and submit plan  Patient has no means to pay 25
  • 26.  DAN ask the Insurance company if they can make an exception  Application is denied  Contact the Pharmaceutical Company Patient Assistance Program to investigate what programs are available to help patients  They offer “An Agreement to Pay”  Our request is accepted The patient can proceed with the treatment 26
  • 27. Case Study #3  Patient with disease progression is referred  Patient has private insurance  The medication is not a benefit under his plan  Make an application to the Insurance company for an Exception to the formulary  Application is denied 27
  • 28.  The drug is NOT publicly funded  Only available to patients with private insurance  No other treatment options for this patient Patient continues to be followed by the Oncologist without treatment… 28
  • 29. Summarize • Who is ODANO? • Backgrounds • Regions • Our referral process – why this role is needed • Benefits to the patient • Benefits to the Centre • How we work together • Challenges / Wish list • Public coverage • Private coverage 29
  • 31. Biography  Michele MacDonald  Drug Access Facilitator  Juravinski Cancer Centre  Hamilton, Ontario  Treasure of Oncology Drug Access Navigators of Ontario (ODAN) O
  • 32.  Has worked at the Juravinski Cancer Centre since October 2007. She started her career in pharmacy working at Shoppers Drug Mart while going to Mohawk College pursuing the pharmacy technician diploma.  After finishing school while still working at Shoppers a job was offered working at the Juravinski Cancer Centre mixing chemotherapy which she continued until 2008 when the drug access job came available.  Michele has also worked at Mohawk College as a teaching assistant in the sterile IV lab course.
  • 33.  Duly licensed as a member of the College of Pharmacists and entitle to practice as a Pharmacy Technician.  Member of the Ontario Pharmacists Association.  Registered with the Pharmacy Examining Board of Ontario  Treasure for Oncology Drug Access navigators of Ontario (ODAN) O
  • 34. Cancer  I was diagnosed with breast cancer on November 4th, 2013. I will never forget the day I heard that news. I was numb, shocked, afraid, and devastated.  How can this be happening to me? It happens to other people not me? In a matter of days my life turned into a complete roller coaster of doctors appointments, ultrasounds, X-rays, MRI, and no more work.  I didn’t have time to process what was happening and I was leaving in 2 days for Cuba. Do I go? I did as I figured it was better to wait for results from the biopsy in the sun then to stew about it at home in the cold.
  • 35. Cancer  C – Courage, Courageous  A – Advocate  N - Never give up  C – Celebrate Life  E – Enthusiastic  R - Research
  • 36. My Journey  The last year and a half has been just a blur, one thing after another. I remember thinking this will be easy I work here, I know what’s going to happen, and it will be fine!! Boy was I wrong I had no idea what I was in for. You have no idea until your on the other side.  First there was the biopsy results, positive for invasive ductal carcinoma. I was blessed at that point that I was given an appointment with the surgical oncologist the next week. A bilateral mastectomy came next and I was definitely not prepared for that. Next came 4 months of chemotherapy as 3 out of the 6 lymph nodes came back with microscopic cells. All I could think about was Oh gosh I’m going to lose my hair!!, not the fact that within weeks I would have toxic drugs running through my veins. Next came the Axillary Node dissection, a procedure in which the next level of lymph nodes are removed. Negative, whew what a relief. Finally some good news for a change. Radiation followed everyday for 6 weeks, I really found out how much I did not know. I was exhausted mentally and physically.
  • 37.  During the whole journey I was also seeing the plastic surgeon who put chest expanders in at the same time as my mastectomy so that I could go through the expansion process. This process includes going to see the doctor every 2 weeks so that he can inject saline into the expanders to gently expand the remaining skin to make room for implants. This unfortunately did not go well. Due to the tissue damage from radiation my skin would not stretch and was incredibly painful. The decision was made for me to undergo a 3rd surgery called a Latissimus Dorsi Flap surgery. This entails removing tissue, muscle and skin from your back and adding onto your front breast area in order to make room for expansion. This was by far my greatest challenge, I was in quite a lot of pain and came home with 3 drains. Homecare nurses would come every 2nd day to check on the incision and drainage.
  • 38.  3 weeks after this last surgery I returned to seeing the plastic surgeon for saline injections into the chest expanders. I am totally relieved that now my skin is stretching out wonderfully and once I get to the desired breast size I wish to be the injections stop.  2 months later I will finally get the implants, we are hoping for July or August, then I get to go back to work. It will almost be 2 full years that I have been off work.
  • 39. Drug Access  Working as a drug access navigator my first concern was what is going to be the drug costs?  I was extremely lucky my husbands coverage was 100% with no co-pays or prior authorization forms  I counted my blessings that this would not be a worry.  When treatment was completed I was shocked at the total amount of prescription costs.  Drug access navigators are definitely a necessity.
  • 40. What have I learned?  Breast Cancer is the 2nd leading cause of death in Canada.  Breast Cancer death rates have gone down in every age group. This reflects the impact of screening and better treatment options.  No one is safe from this disease!! If it happened to me it can happen to you  Cancer does not discriminate.
  • 41. Working in Health Care  Working as a drug access facilitator and going through cancer myself will allow me to be able to do my job better when I return to work. I have always tried to look normal, do my make-up, dress nice, and have a smile on my face. Even though I felt terrible, it didn’t mean I was fine. I will definitely have more patience for people because you never know what may be going on with them.  My co-workers were the best. It was a very heartwarming experience to see how much I was cared for. Not one chemo session went by where I didn’t have the staff coming to cheer me up. Working in the environment that we do certainly does make the journey go easier but it is still overwhelming.
  • 42. Final Thoughts  I came from a pretty close family, but it definitely made us closer as a whole and really makes you enjoy every minute you have.  Ask for help. Don’t wait for offers. Other people can cook for you, clean for you, do laundry, errands or banking. Only you can fight the cancer!!!  I learned that I can put myself first, this is the first time in my life that I can honestly say I learned to do that.
  • 43.  Focus on the present and use your energy to focus on treatment and getting better. Dwelling on what you can’t change will only cause you to lose the ability to cope.  You can sit and cry or feel sorry for yourself, or you can choose to be strong and positive. Trust me, it will make you stronger, more positive and change your outlook on life. In some ways, cancer was a good thing for me. A perfectionist who now can slow down, relax, and enjoy life.
  • 45. Canadian Cancer Survivor Network Contact Info Canadian Cancer Survivor Network 1750 Courtwood Crescent, Suite 210 Ottawa, ON K2C 2B5 Telephone / Téléphone : 613-898-1871 E-mail jmanthorne@survivornet.ca or mforrest@survivornet.ca Web site www.survivornet.ca Blog: http://jackiemanthornescancerblog.blogspot.com/ Twitter: @survivornetca Facebook: www.facebook.com/CanadianSurvivorNet Pinterest: http://pinterest.com/survivornetwork/

Editor's Notes

  1. We are not connected as members Organization formed to bring us all together share resources Form a network – master email distribution list Weekly / monthly WebX’s + TC’s our job descriptions might be different according to our centre’s need Common goal is to advocate for the patient Secure the best possible funding for the patient’s treatment
  2. Funding models are different Job descriptions vary Common goal to advocate for patient Maximize funding for the patient
  3. SAP provides access to non marketed drugs -
  4. Be mindful: Does the patient have access to private insurance? Some drugs are only funded by Private Insurance No public funding - they have not been added to the MOH formulary Be mindful of the lines of therapy….and funding. The MOH will only fund certain drugs when prescribed in a certain sequence Make sure that future treatments are not jeopardized The final decision is the Physicians – we do the investigative work
  5. Raises anxiety in patients Publicly funded drugs with the MOH - a 2 step process Firstly need to request approval to use the drug in a particular setting / criteria met then you need to find appropriate funding Triilim Community Care Access Program – CCAC temporary drug cards Long term facility ODSP Social Works Often - When EAP approval Is received – misconception that treatment can begin
  6. My Journey, through the eyes of a drug access facilitator