Medical coverage for treatment

If the first-line treatment regimen recommended by your physician is not eligible for coverage by your provincial/territorial worker's compensation board or your provincial/territorial drug plan, ask your doctor to refer you to a Drug Access Facilitator and/or a Patient Assistance Program.  A Drug Access Facilitator or a Patient Assistance Program can help you navigate the various programs and options available to you.  Drug Access Canada provides healthcare professionals with in depth information of drug Patient Support Programs.

Drug Access Facilitators

Drug Access Facilitators may work for the hospital or cancer treatment centre where you will receive treatment. They have experience navigating existing programs to secure medications that are not covered for patients who need them. These medications may be obtained at little or no cost to the patient. This may be done through “compassionate grounds” applications to the drug manufacturers. Some programs request that your health information be shared with them so that they can track the success of their product in treating the medical condition for which they are being used. If you work with a Drug Access Facilitator, you may be directed to a Patient Assistance Program (PAP).

Patient Assistance Program (PAP)

In the simplest terms, a PAP is a pharmaceutical company that assigns case workers to help you navigate the provincial system or private insurance in order to get you the medications or treatments you require. In some cases, the case worker will act on your behalf in filing your claim with the relevant worker’s compensation board. Case workers are experienced in communicating with government agencies and insurance companies (they may have worked for the insurance companies or worker’s compensation board in the past) and know the ins and outs of the documentation that needs to be submitted to have a claim approved.

To qualify for direct financial assistance from the pharmaceutical company, individuals usually must be referred to the program by a physician and must satisfy a number of eligibility criteria.  Financial need is typically a key criterion. If the relevant drug manufacturer sponsors or pays for the program, the services will be offered to the patient free. The advantage to the patient is that he or she gets the necessary medications/treatments. The advantage to the drug manufacturer is that it is able to sell more of its products to those who need them for a course of treatment.  If the relevant drug manufacturer does NOT sponsor the program, the patient will have to pay the PAP fees for service.

PAPs for drugs to treat mesothelioma include: