In this presentation, Alan Birch discussed the role of an Oncology Drug Access Navigator as well as how the role fits into the healthcare team and what they help patients with. He gave a brief overview and history of the role as well as discussing challenges faced by patients and how National Pharmacare may impact it all. The webinar was followed by an interactive question & answer session. About the presenter: Alan Birch is an Oncology Drug Access Navigator at North York General Hospital. He is a member of ODANO, the oncology drug access navigators of Ontario and has been in the role for the last 5 years. Alan is a registered pharmacy technician by background and is also a member of the Ontario College of Pharmacists and Ontario Pharmacist's Association.

1. Oncology Drug Access Navigators
Benefits to Patients and Healthcare teams
By: Alan Birch, RPhT

2. Background
• My name is Alan Birch.
• I am an oncology Drug Access Navigator at North York
General Hospital in Toronto.
• I have been in my role for over 5 years.
• I am a member of the Oncology Drug Access
Navigators of Ontario (ODANO).

3. Agenda
• Why do we have Drug Access Navigators?
• The Oncology Drug Access Navigators of
Ontario (ODANO).
• Case Study of how we help patients.
• National Pharmacare.
• Wish List

4. Why Drug Access Navigators?
• Our first oncology Drug Access Navigator
started in Ontario in 2007.
• This role began to help with complexities in
drug reimbursement in oncology clinics.
• While IV cancer drugs in Ontario are funded by
Cancer Care Ontario (CCO), while the others
are through the Ontario Drug Benefit (ODB) for
orals and injections.

5. Why Drug Access Navigators?
• As experts in oncology drug access, we are
able to help connect patients with the
treatments prescribed by their physician.
• This can be through public insurance, private
insurance or from a pharmaceutical patient
program. Sometimes patients need a mix of all
three!

6. Why Drug Access Navigators?
• While most drugs are funded through the
government, often newer therapies are
accessed through pharmaceutical patient
programs or the Health Canada special access
program (SAP).
• DANs are a knowledge base physicians can
turn to to know what can be accessed for a
patient.

7. Our roles across Canada
• Besides Ontario, Drug Access Navigators exist
in British Columbia, Alberta, Quebec and the
Atlantic provinces.
• Everyone’s role is a little different, but the goal
remains the same: our commitment to getting
patients the treatment they need as quick and
cost effective as possible.

8. The Healthcare Team

9. Oncology Drug Access Navigators of Ontario
• In Ontario, where almost every cancer centre
has at least 1 drug access navigator, we have
formed a network called ODANO.
• ODANO is a network where we can help each
other, which in turn, helps our patients.

10. ODANO
• We share experiences and resources with
fellow Drug Access Navigators around the
province.
• We do this by sharing files or using our
experience with a drug to help a newer
Navigator that’s less familiar.
• We also have a website full of useful
information at www.odano.ca

11. Finding a Navigator
• A common question is how does one find a
navigator. Since most cancer centres have one,
you should ask you physician how to reach
one.
• If you’re in Ontario, ODANO can connect your
direct with your local Drug Access Navigator
through the Contact Us section of our website.

12. Finding a Navigator

13. Ontario Drug Reimbursement
• In Ontario, cancer drugs are publicly funded
through 2 methods. They are Cancer Care
Ontario for IV therapies and the Ontario Drug
Benefit for orals and injections.
• While IV therapies are paid for 100% by the
hospital and then reimbursed by CCO, orals
and injections require additional steps.

14. Ontario Drug Reimbursement
• Ontarians over 65 and under 25 have full ODB
drug coverage.
• Those between 25 and 65 have access to this
government coverage through the Trillium
Drug Program.
• Trillium enrolled patients have a deductible of
4% of net household income.
• To qualify for Trillium, you just need OHIP.

15. Private Drug Coverage
• Around 30% of Canadians get their drugs
through private insurance plans.
• When it comes to cancer drugs, this usually
means Prior Authorization forms to get
approval from the insurer to access the drug.
• Often private insurance plans have annual
financial caps and copays/ deductibles.

16. Case Study
• Relapsing 62 year multiple myeloma patient that has had
CyBorD and autologous stem cell transplant. She has a
private insurance plan.
• Her hematologist would like to use Darzalex (daratumumab)
in combination with Revlimid (lenalidomide) and
dexamethasone.
• Based on pCODR’s report, this combination will cost
approximately $6,697 (Darzalex) + $8,904 (Revlimid) and
$12.18 (dexamethasone) = $15,613 per month after the more
expensive first few cycles are complete.
• Referral is made to DAN

17. Case Study
• Investigation into her private plan:
• Drugs are covered at 80%.
• Plan has no annual maximum
• Prior approval is needed for Darzalex and
Revlimid.
• Privately paid IV therapies cannot be given in
hospitals.

18. Case Study
• What can be done?
• Drug Access Navigator submits prior authorization
forms with clinical references and physician letters to
insurance for review.
• Enrol her with manufacturer’s Patient Support
Programs for 20% copay assistance and private
infusion coordination.
• Enrol her with the Trillium Drug Program for Revlimid
copay assistance and arrange to have application
expedited.

19. Case Study
• Outcome:
• After 9 days, her insurance has approved her
prior authorization requests for Darzalex and
Revlimid.
• She is scheduled to start her new treatment
shortly after.
• Total funding has been secured for all of the
prescribed medications.

20. National Pharmacare
• The big topic going into 2019, is National
Pharmacare and what it may look like.
• It remains unclear what will be proposed in
Spring 2019 by Dr. Eric Hoskins and his
implementation committee.
• How may the role of the Drug Access
Navigator change?

21. National Pharmacare
• If private insurance remains post-National
Pharmacare, DANs will still be assisting
physicians and patients with forms and patient
programs for financial assistance with copays.
• Many provinces require prior approval for
certain medications. This often includes cancer
drugs.

22. National Pharmacare
• There is a time delay between Health Canada
approval and public funding for drugs. The gap
in cancer care is often filled by patient
programs providing the drug for free.
• The Special Access Program through Health
Canada is used to access drugs from outside of
Canada. This too, would still exist with
National Pharmacare.

23. Wish List
• How can we make the drug access process
better for patients now?
• More electronic systems. Whether it is the
Ministry of Health, private insurance or drug
companies, paper and faxing is everywhere.
• Online Trillium portal, electronic EAPs and
insurance prior authorizations to make
processes faster and easier.

24. Wish List
• Improved request processing times. Cancer is
urgent and treatment needs to be started
yesterday.
• When insurance and government take 2 weeks
or more sometimes to make a decision,
patients can suffer. A fair wait time should be
no more than 3 business days.

25. Wish List
• Bring down the silos. As we move towards more
combination therapies in cancer, drugs are coming
from different funding sources. Sometimes IV is
given with an oral treatment. Or 2 IV therapies from
different companies or different funding sources or
specialty pharmacies.
• All these players don’t necessarily communicate
with each other. This can harm patients and is a
burden to coordinate.

26. How to reach ODANO
• Visit our new website at:
www.odano.ca
• Follow us on Twitter & Facebook
@Odanocanada

27. Canadian Cancer Survivor Network Contact
Info
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2C 2B5
Telephone / Téléphone : 613-898-1871
E-mail: jmanthorne@survivornet.ca or info@survivornet.ca
Website: www.survivornet.ca
Twitter: @survivornetca
Facebook: www.facebook.com/CanadianSurvivorNet
Instagram: @survivornet_ca
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