PATIENT ASSISTANCE PROGRAMS

Transcription

1 PATIENT ASSISTANCE PROGRAMS Definitions SAP Class I Class II BC Cancer Agency Health Canada Special Access Program Reimbursed for active cancer or approved treatment or approved indication only 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 Reimbursement for approved indications only. Completion of the 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. H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 1/32

2 Home injection programs DRUG SUPPLIER CLASS PROGRAM INFORMATION Buserelin (SUPREFACT ) Degarelix (FIRMAGON ) Goserelin (ZOLADEX ) Sanofi-Aventis Class I SUPREFACT Home Injection Program Medicum Patient Assistance Program Tel: Fax: 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) Ferring Class I Coverdale Clinics - Firmagon Injection Program Tel: Fax: Ten fully operational clinics across BC Physician enrolls patient on the program for administration at a nearby clinic. TerSera Class I ZOLADEX Community Care and Home Injection Program Tel: Fax: Home Injection Program (free of charge) H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 2/32

3 DRUG SUPPLIER CLASS PROGRAM INFORMATION Lanreotide (SOMATULINE ) Leuprolide (ELIGARD ) Leuprolide (LUPRON ) Ipsen Class I or based on indication IPSEN CARES Program Tel: Fax: 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) Sanofi-Aventis Class I ELIGARD Home Injection Program Tel: Fax: 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) AbbVie Class I LupronCares Support Program Tel: Fax: 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) H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 3/32

4 DRUG SUPPLIER CLASS PROGRAM INFORMATION Octreotide (SANDOSTATIN ) Novartis Pharmaceuticals Class I Access SANDOSTATIN LAR Tel: Fax: Help for patients to obtain third party coverage Financial assistance may be provided Home injection service (free of charge) H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 4/32

5 Supportive care medications DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Aprepitant (EMEND ) Merck PharmaCare Special Authority required. Dalteparin (FRAGMIN ) Pfizer Funded by for approved indications for inpatient use only. Funded by for approved indications for inpatient use only. Merck Canada Patient Assistance Program Tel: Fax: 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 Fragmin First Dose Program Tel: Fax: 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. H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 5/32

6 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Darbepoetin (ARANESP ) Amgen VICTORY Program Tel: Fax: 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 Not required Eltrombopag (REVOLADE ) Novartis pharmacy inreach Patient Support Program Tel: Fax: 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. H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 6/32

7 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Epoetin Alfa (EPREX ) Janssen SPECTRUM Support Program for Eprex Tel: Fax: 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 Not required Filgrastim (GRASTOFIL ) Apotex Funded by for approved indications for inpatient use only. will coordinate nurse home visit with patient Apobiologix ANSWERS Patient Support Program Tel: Fax: 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. H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 7/32

8 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Filgrastim (NEUPOGEN ) Amgen PharmaCare Special Authority required. Pegfilgrastim (NEULASTA ) Amgen Funded by for approved indications for inpatient use only. VICTORY Program Tel: Fax: 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 VICTORY Program Tel: Fax: 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 H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 8/32

9 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Posaconazole (POSANOL ) Merck Canada Merck Care Oncology Tel: Fax: Financial assistance is available to eligible patients with third party insurance coverage but may need help with the co-pay Not required Valacyclovir (VALTREX ) GlaxoSmithKline Compassionate supply available VALTREX Patient Assist Program Tel: Web: 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 H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 9/32

10 DRUG SUPPLIER CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Vorinostat (ZOLINZA ) Merck Canada Merck Care Oncology Tel: Fax: 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 H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 10/32

11 Drugs with assistance/reimbursement programs and/or coordination of insurance coverage DRUG SUPPLIER CLASS PROGRAM INFORMATION Abiraterone (ZYTIGA ) Afatinib (GIOTRIF ) Alectinib (ALECENSARO ) Janssen Boehringer Ingelheim Roche Janssen BioAdvance ZYTIGA Drug Access and Patient Support Program Tel: zytiga@bioadvanc .ca 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) HeadStart Patient Assistance Program Tel: Fax: 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: Roche Patient Assistance Program (RPAP) Tel: Fax: Financial assistance is available to all patients with third party H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 11/32

12 DRUG SUPPLIER CLASS PROGRAM INFORMATION Alemtuzumab (CAMPATH ) Anastrozole (TEVA brand) Atezolizumab (TECENTRIQ ) Axitinib (INLYTA ) Bevacizumab (AVASTIN ) Genzyme Class I Clinigen Group Tel: Fax: Teva Class I TEVA Compassionate Care Program Tel: Compassionate access is available to eligible patients Application form is to be sent by mail or courier, and must be Roche Pfizer Roche Class I or based on indication accompanied by original prescription Roche Patient Assistance Program (RPAP) Tel: Fax: This bridging program will provide financial assistance to eligible patients, on a case-by-case basis Pfizer Liaison Patient Support Program Tel: Fax: Financial assistance may be available on a case-by-case basis Roche Patient Assistance Program (RPAP) Tel: Fax: Financial assistance is available to all patients with third party Infusion coordination provided if required H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 12/32

13 DRUG SUPPLIER CLASS PROGRAM INFORMATION Bendamustine (TREANDA ) Bosutinib (BOSULIF ) Lundbeck Pfizer TREANDA Patient Support Program Tel: Fax: No compassionate supply available Infusion coordination provided if required Pfizer Liaison Patient Support Program Tel: Fax: Financial assistance may be available on a case-by-case basis Cabazitaxel (JEVTANA ) Capecitabine (TEVA brand) Sanofi Teva Class I or based on indication Sanofi Cancer Patient Assistance Program Tel: SANOFI Fax: TEVA Compassionate Care Program Tel: Compassionate access is available to eligible patients Application form is to be sent by mail or courier, and must be accompanied by original prescription H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 13/32

14 DRUG SUPPLIER CLASS PROGRAM INFORMATION Carfilzomib (KYPROLIS ) Amgen VICTORY Program Tel: Fax: insurance coverage but may need help with co-pay Compassionate supply available Ceritinib (ZYKADIA ) Cobimetinib (COTELLIC ) Novartis Roche My Lungs Program Tel: Fax: 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 Roche Patient Assistance Program (RPAP) Tel: Fax: Financial assistance is available to all patients with or without third party insurance Bridging program ceases November 11, 2017 H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 14/32

15 DRUG SUPPLIER CLASS PROGRAM INFORMATION Crizotinib (XALKORI ) Pfizer Pfizer Liaison Patient Support Program Tel: Fax: Financial assistance may be available on a case-by-case basis Dabrafenib (TAFINLAR ) Daratumumab (DARZALEX ) GlaxoSmithKline Janssen inreach Patient Support Program Tel: Fax: 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 Janssen BioAdvance DARZALEX Drug Access and Patient Support Program Tel: darzalex@bioadvanc .ca 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 H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 15/32

16 DRUG SUPPLIER CLASS PROGRAM INFORMATION Dasatinib (SPRYCEL ) Denosumab (XGEVA ) Doxorubicinpegylated liposomal (CAELYX ) BMS Amgen Access to Hope Program Tel: Fax: Financial assistance and compassionate supply available to all patients with or without third party insurance coverage on a case-by-case evaluation VICTORY Program Tel: Fax: Janssen Class I Richard K. Plante, Director of Oncology, Janssen Tel: Mobile: rplante@its.jnj.com Durvalumab (IMFINZI ) AstraZeneca or Myrna O Brodovich, Medical Information, Janssen Tel: medinfocanada@joica.jnj.com AstraZeneca Oncology Patient Support Program Tel: Fax: Health Canada approved indication only Financial assistance available based on financial need and availability of third party insurance coverage Coordination with private infusion clinic H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 16/32

17 DRUG SUPPLIER CLASS PROGRAM INFORMATION Enzalutamide (XTANDI ) Eribulin (HALAVEN ) Erlotinib (TARCEVA ) Astellas Eisai Roche Class I or based on indication XTANDI Patient Assistance Program Tel: Fax: Financial assistance is available to all patients with or without third party insurance Home delivery available through McKesson Pharmacy Eisai Assistance Program Tel: Fax: No compassionate supply available Infusion coordination provided if required Roche Patient Assistance Program (RPAP) Tel: Fax: 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 H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 17/32

18 DRUG SUPPLIER CLASS PROGRAM INFORMATION Everolimus (AFINITOR ) Exemestane (TEVA brand) Fulvestrant (FASLODEX ) Novartis Class I or based on indication AfiniTRAC Reimbursement Support Program Tel : Fax : Teva Class I TEVA Compassionate Care Program Tel: Compassionate access is available to eligible patients Application form is to be sent by mail or courier, and must be accompanied by original prescription AstraZeneca Patient Assistance Program Tel: Fax: enrollment@azoncologypsp.ca 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 H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 18/32

19 DRUG SUPPLIER CLASS PROGRAM INFORMATION Ibrutinib (IMBRUVICA ) Idelalisib (ZYDELIG ) Imatinib (GLEEVEC ) Imatinib (TEVA brand) Janssen Gilead Novartis Teva Class I or based on indication Class I or based on indication Janssen BioAdvance IMBRUVICA Drug Access and Patient Support Program Tel: imbruvica@bioadvanc .ca Financial assistance is available to all patients with or without third party insurance Compassionate drug access may be available Home delivery available Drug Access Special Assistance (DASA) for previously untreated patients with CLL program ending upon provincial reimbursement Gilead Oncology Patient Support Program Tel: Fax: Financial assistance is available to patients with or without third party insurance Compassionate supply may be available GIST Alliance Tel: Fax: Program covers up to 20% of drug cost TEVA Compassionate Care Program Tel: Compassionate access is available to eligible patients Application form is to be sent by mail or courier, and must be accompanied by original prescription H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 19/32

20 DRUG SUPPLIER CLASS PROGRAM INFORMATION Interferon alpha (INTRON A ) Ipilimumab (YERVOY ) Irinotecan liposome (ONIVYDE ) Ixazomib (NINLARO ) Merck Class I Merck Care TM Oncology Tel: Fax: BMS Baxalta / Shire Takeda Canada ACCESS TO HOPE Program Tel: Fax: % co-pay assistance available to all patients Reimbursement navigation Infusion clinic coordination onward patient support program Tel: Fax: Compassionate supply available NINLARO Compassionate Access Program Tel: Fax: ninlaro.canada@takeda.com Compassionate supply available on a case-by-case assessment Tel/Fax/ to obtain Compassionate Access Request Form. H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 20/32

21 DRUG SUPPLIER CLASS PROGRAM INFORMATION Lapatinib (TYKERB ) Lenalidomide (REVLIMID ) Lenvatinib (LENVIMA ) Letrozole (FEMARA ) GlaxoSmithKline Celgene Eisai inreach Patient Support Program Tel: Fax: Financial assistance is available to patients with or without third party insurance. Patients may be asked to co-pay based on household income RevAid program Tel: Fax: Web: Financial assistance is available to all patients with or without third party insurance coverage Compassionate supply may be available for non- funded indications EISAI CARES Patient Support Program Tel: Fax: Novartis Class I Access FEMARA Tel: Fax: Compassionate supply of FEMARA available based on financial need H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 21/32

22 DRUG SUPPLIER CLASS PROGRAM INFORMATION Letrozole (TEVA brand) Nilotinib (TASIGNA ) Nivolumab (OPDIVO ) Teva Class I TEVA Compassionate Care Program Tel: Compassionate access is available to eligible patients Application form is to be sent by mail or courier, and must be accompanied by original prescription Novartis BMS The Alliance Patient Support Program Tel: Fax: ACCESS TO HOPE Program Tel: Fax: % 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 ipilimumab in treatment-naïve melanoma) Program enrolment ends May 2018 H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 22/32

23 DRUG SUPPLIER CLASS PROGRAM INFORMATION Obinutuzumab (GAZYVA ) Olaparib (LYNPARZA ) Osimertinib (TAGRISSO ) Roche AstraZeneca AstraZeneca Roche Patient Assistance Program (RPAP) Tel: Fax: Financial assistance is available to patients who have third party, on a case-bycase basis AstraZeneca Oncology Patient Support Program Tel: Fax: Compassionate supply available for patients without third party insurance (Health Canada approved indication only) AstraZeneca Oncology Patient Support Program Tel: Fax: Compassionate supply available H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 23/32

24 DRUG SUPPLIER CLASS PROGRAM INFORMATION Paclitaxel-nab (ABRAXANE ) Palbociclib (IBRANCE ) Panitumumab (VECTIBIX ) Celgene Class I ABRAXANE Access Program Tel: Fax: Financial assistance is available for non- 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 Pfizer Amgen Class I or based on indication Pfizer Liaison Patient Support Program Tel: Fax: 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 VICTORY Program Tel: Fax: Financial assistance available to patients without third party insurance coverage on a case-by-case evaluation H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 24/32

25 DRUG SUPPLIER CLASS PROGRAM INFORMATION Pazopanib (VOTRIENT ) Pembrolizumab (KEYTRUDA ) GlaxoSmithKline Merck Canada inreach Patient Support Program Tel: Fax: Financial assistance is available to patients with or without third party insurance. Patients may be asked to co-pay based on household income MERCK CARE Oncology Patient Assistance Program Tel: Fax: Enrolment criteria: Metastatic NSCLC with PD-L1 expression ( 50% by validated test) with disease progression on or after platinumcontaining 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: or keytruda@bayshore.ca Assistance offered to Healthcare professionals: PD-L1 status determination is coordinated through the hospital/agency laboratory or through MERCK CARE Oncology Patient Assistance Program. H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 25/32

26 DRUG SUPPLIER CLASS PROGRAM INFORMATION Pemetrexed (ALIMTA ) Pertuzumab (PERJETA ) Pomalidomide (POMALYST ) Lilly Roche Celgene Class I or based on indication ALIMTA Assistance with Reimbursement of Cost (ARC) Program Tel: Fax: Coordination of third party insurance coverage, including WorkSafeBC Based on financial need: o Financial assistance may be available to patients who have third party o Compassionate supply may be available Roche Patient Assistance Program (RPAP) Tel: Fax: Financial assistance is available to all patients with or without third party insurance RevAid program Tel: Fax: Web: Financial assistance is available to all patients with or without third party insurance coverage Compassionate supply may be available for non- funded indications H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 26/32

27 DRUG SUPPLIER CLASS PROGRAM INFORMATION Ponatinib (ICLUSIG ) Paladin funding based on indication ICLUSIG Patient Support Program Tel: Fax: Coordination of third party insurance coverage Ramucirumab (CYRAMZA ) Regorafenib (STIVARGA ) Rituximab (RITUXAN ) Lilly Bayer Roche Class I or based on indication ENCIRCLE Patient Support Program Tel: Fax: Compassionate drug supply may be available Program closed to new enrollment as of May 01, 2017 BTHER4U Patient Support Program Tel: THER4U Fax: THER4U Financial assistance available to all patients with or without third party insurance coverage Compassionate supply may be available Roche Patient Assistance Program (RPAP) Tel: Fax: Infusion coordination provided if required H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 27/32

28 DRUG SUPPLIER CLASS PROGRAM INFORMATION Romidepsin (ISTODAX ) Romiplostim (NPLATE ) Ruxolitinib (JAKAVI ) Siltuximab (SYLVANT ) Celgene Amgen Novartis Janssen ISTODAX Access Program Tel: Fax: Financial assistance available on a case-by-case basis Coordination of third party insurance coverage No compassionate supply available enable Support Program Tel: Fax: No compassionate assistance available The Alliance Patient Support Program Tel : Fax : Janssen Compassionate Use Program Tel: Fax: JanssenMedSci@its.jnj.com Compassionate supply available for those who qualify H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 28/32

29 DRUG SUPPLIER CLASS PROGRAM INFORMATION Sorafenib (NEXAVAR ) Sunitinib (SUTENT ) Temozolomide (TEMODAL ) Temsirolimus (TORISEL ) Bayer Pfizer BTHER4U Patient Support Program Tel: THER4U Fax: THER4U Financial assistance available to all patients with or without third party insurance coverage Compassionate supply may be available Pfizer Liaison Patient Support Program Tel: Fax: Financial assistance may be available on a case-by-case basis Merck Class I Merck Care TM Oncology Tel: Fax: Pfizer Pfizer Liaison Patient Support Program Tel: Fax: Financial assistance may be available on a case-by-case basis H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 29/32

30 DRUG SUPPLIER CLASS PROGRAM INFORMATION Thalidomide (THALOMID ) Tocilizumab (ACTEMRA ) Trametinib (MEKINIST ) Celgene Roche GlaxoSmithKline RevAid program Tel: Fax: Web: Financial assistance is available to all patients with or without third party insurance coverage Compassionate supply may be available for non- funded indications JointEffort program Tel: Fax: inreach Patient Support Program Tel: Fax: 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 H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 30/32

31 DRUG SUPPLIER CLASS PROGRAM INFORMATION Trastuzumab (HERCEPTIN ) Trastuzumab Emtansine (KADCYLA ) Vandetanib (CAPRELSA ) Roche Roche Sanofi Genzyme Class I or based on indication Roche Patient Assistance Program (RPAP) Tel: Fax: Infusion coordination provided, if required Roche Patient Assistance Program (RPAP) Tel: Fax: Infusion coordination provided, if required CAPRELSA Distribution Program Tel: Fax: Web: 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 H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 31/32

32 DRUG SUPPLIER CLASS PROGRAM INFORMATION Vemurafenib (ZELBORAF ) Venetoclax (VENCLEXTA ) Vismodegib (ERIVEDGE ) Roche AbbVie Roche Roche Patient Assistance Program (RPAP) Tel: Fax: Financial assistance is available to all patients with or without third party insurance Bridging program ceases November 11, 2017 AbbVie Care Program Tel : Fax : Assistance offered : Compassionate supply may be available Roche Patient Assistance Program/ERIVEDGE Pregnancy Prevention Program (RPAP/EPPP) Tel: Fax: Drug can only be dispensed to patients who are registered and meet all conditions of the EPPP. For more information contact EPPP at Date updated: 01 Dec 2017 (updated: fulvestrant, ipilimumab, nivolumab; new: durvalumab, irinotecan liposome) Date created: 17 Oct 2008 H:\Pharm-prov\Provincial DI Coordinator\Protocol\Patient Assistance Programs 32/32