Questions and Experts Session Guide: A Drug Access Navigator Answers Questions about Accessing Breast Cancer Drugs in Canada

A breast cancer diagnosis comes with so many questions and there never seems to be enough time at appointments to have some of these questions answered. To help address this, we developed a "Q&E: Questions and Experts" series. In this series, a variety of experts spend the entire virtual session answering pre-submitted and live questions from participants. Watching the videos on-demand might be a little difficult to get through. So, we’ve created this guide to help you get right to the questions and answers that matter the most to you.

In today’s post, we provide the questions that were sent in and asked during the live session of our Questions and Experts session held in October 2021. In this session, Michele MacDonald, RPhT, a Regulated Pharmacy Technician a Drug Access Navigator, answered questions about accessing breast cancer drugs in Canada. In the parentheses, you’ll find the timestamp of where to find the question in the on-demand video.

On Drug Access Navigators

1. What is a Drug Access Navigator or Facilitator and what role do they play as part of the healthcare team? (00:03:19)

2. If there are diagnostic tests that a patients should be having, are you able to help apply for some of the compassionate funding for that or is that currently not within the Drug Access Navigator portfolio? (00:16:13)
3. As someone who navigates patients through this incredibly complex system, what would you like to see implemented to make things easier for patients to access treatments? (00:48:32)
4. Do Drug Access Navigators get advanced notice of what’s coming down the pipeline on some drugs? (01:15:21)
5. Do Drug Access Navigators get a heads up on what’s in the early stages of clinical trails or even at bench research? (01:15:55)
6. Given that you’re both a healthcare professional and a patient, what is something that we haven’t addressed in this session that you think is important for patients to know? (01:17:38)

Accessing a Drug Access Navigator

1. How would a patient know that there is a Drug Access Navigator in the cancer center that they are being treated at? Do all centers have navigators, and could they still connect with someone if the cancer center does not provide one? (00:04:18)

2. If someone comes in and is newly diagnosed cancer diagnosis and doesn’t understand that there is such an access, who would relay that information to this patient? (00:05:36)
3. Can patients self-refer to a Drug Access Navigator through the ODANO website? (00:06:51)
4. For patients who are not being treated in Ontario, for example if they are being treated at Manitoba Cancer Care, if they were to type in and ask a question to ODANO could they be navigated to somewhere in Manitoba or their province? (00:07:56)
5. In terms of standardizing these processes, would you know, or do you think that it’s the same across the country in each province? (00:23:13)

Funding and Financial Support

General Funding and Financial Support

1. If a treatment that my oncologist recommends isn’t covered through public provincial funding, where else might I find funding for this? (00:08:41)
2. Does anybody get denied for funding of some kind? (00:11:01)
3. This patient was recently diagnosed with breast cancer and will be having surgery, radiation, and hormone therapy. Are there expenses that will not be covered that I should anticipate? I’m trying to plan for any financial impact this will have. (00:18:08)
4. Do you have any insights on the private insurance navigation versus public? Are there differences in terms of ease of access? (00:21:04)
5. Are oncologists actively aware of the drugs that are available that are not funded by the provincial healthcare programs? (00:38:29)
6. How important is it for a patient to also be part of the navigation of accessing breast cancer drugs and funding? (00:51:16)

Accessing Various Funding Programs

1. Can patients submit the forms to the various drug funding programs, or does this need to be done by a doctor or other healthcare professionals? (00:12:27)
2. If funding has been denied, is there an appeals process? (00:14:10)
3. Can you tell us more about the compassion program for patients with ports or PICC lines? (00:15:32)
4. If there are diagnostic tests that a patients should be having, are you able to help apply for some of the compassionate funding for that or is that currently not within the Drug Access Navigator portfolio? (00:16:13)
5. Could you speak to manufacturer patient support programs, what are these and how can I access these? (00:24:32)
6. Can patients reach out directly to drug access programs to self-refer? Can they get in touch with the manufacturer directly or whoever’s supporting these programs, or do they need to go through their oncologist or a Drug Access Navigator for those? (00:26:00)
7. If a patient has to travel outside of Canada for treatment, what’s the process for that and is there support through Health Canada’s special access program? (00:29:22)
8. Can you explain what SAP (special access program) forms are? (00:32:10)
9. Are any natural treatments or supplements, specifically medical cannabis oil, covered through any programs or is a Drug Access Navigator able to help find coverage for those various treatments for patients? (00:35:30)
10. What’s the extent of time that usually these drugs are on compassionate care? (00:45:45)
11. What do you do to the patients then that haven’t met the criteria or miss the deadline to be on a patient support program? (00:57:17)
12. Do you see patients forego a drug completely because they cannot afford even the smaller amount of costs to be on those drugs? (00:58:36)
13. I was recently treated for early-stage breast cancer and worked through a Drug Access Navigator. However, I didn’t know that there was a list of patient support programs, ODANO or the CBCN. How do we make sure that patients can access funding information? (01:04:53)
14. Is there ever a situation where programs close abruptly without any notice, or do they usually stick to their timeline? (01:13:46)

Accessing Breast Cancer Drugs

1. If drugs are not approved in one province but are covered in another province, in the U.S. or in another country, can patients access them? (00:27:29)
2. If a patient has to travel outside of Canada for treatment, what’s the process for that and is there support through Health Canada’s special access program? (00:29:22)
3. Lynparza (Olaparib) has Health Canada approval to treat BRCA mutated prostate cancer however, it seems as though it’s being used in other countries for treatment of BRCA mutated breast cancers. Are you able to speak to the status of this in Canada? (00:33:17)
4. Are there any types of drugs that you have noticed patients having difficulty accessing? (00:42:08)
5. If someone has been diagnosed with metastatic breast cancer and they’ve been on Ibrance, would they qualify for a boost drug to help bring their white blood cells up? (00:47:24)
6. How important is it for a patient to also be part of the navigation of accessing breast cancer drugs and funding? (00:51:16)
7. Does drug eligibility include undergoing treatments that are approved and funded before being able to access drugs that may be more applicable but not funded? (01:08:04)
8. This patient has HER2-positive metastatic breast cancer for almost three years. She’s still on her first line of Herceptin and Perjeta and she’s never spoken to a Drug Access Navigator and this line has treated her well. If and when I need my second line how do I know the one they offer is the best one to do? (01:10:18)

Drug Coverage Across Canada

1. In terms of standardizing these processes, would you know, or do you think that it’s the same across the country in each province? (00:23:13)

2. If drugs are not approved in one province but are covered in another province, in the U.S. or in another country, can patients access them? (00:27:29)
3. Do patients across Canada have access to all the same breast cancer drugs? (00:37:42)
4. I live in Quebec and need a drug in Ontario, would I have to live in Ontario for three months before I’m covered under the Ontario program? (00:46:56)
5. Do you think that a national pharmacare will make things better and less time consuming for the oncologist but also, for the Drug Access Navigator, in terms of trying to access drugs for patients? (01:06:32)
6. Which province has the most drugs publicly funded? (01:16:57)

Patient Involvement and Advocacy

1. Can patients self-refer to a Drug Access Navigator through the ODANO website? What about patients who are not in Ontario, can they also refer to the ODANO website? (00:06:51)

2. Can patients submit the forms to the various drug funding programs, or does this need to be done by a doctor or other healthcare professionals? (00:12:27)
3. Can patients reach out directly to drug access programs to self-refer? Can they get in touch with the manufacturer directly or whoever’s supporting those drug access program or patient support programs, or do they need to go through their oncologist or a Drug Access Navigator for those? (00:26:00)
4. How important is it for a patient to also be part of the navigation of accessing breast cancer drugs and funding? (00:51:16)
5. In order to have patients involved in their care, is there an avenue where patients can add information to their electronic medical record or where you can have payer information added in there? (00:55:17)
6. Given that you’re both a healthcare professional and a patient, what is something that we haven’t addressed in this session that you think is important for patients to know? (01:17:38)

Photo by Jodie Cook on Unsplash