What is a “Drug Access Navigator”?
An oncology drug access navigator is a hospital employee who works on a referral from the oncology team to investigate and coordinate funding for a patient’s prescribed drug therapy. This funding may be through the patient’s own prescription drug plan or through other resources. Unfortunately, not all drugs used in the treatment of cancer are covered universally (see Understanding Drug Coverage section). The focus of the oncology drug access navigator is to coordinate funding for those drugs not funded through the hospital formulary.
The oncology drug access navigator examines all possible options for funding and takes some of the burden off patients in coordinating this part of their care. Each navigator stays up to date on drug plan submission processes, temporary drug release programs, and financial assistance options. Their role is to keep both the patient and the oncology team informed and to keep the treatment plan moving smoothly.
What They DO
The functions of an oncology drug access navigator vary within each hospital. Most oncology drug access navigators in Atlantic Canada help patients with funding challenges for both TREATMENT drugs (e.g. chemotherapy, hormone inhibitors, targeted treatments, immunotherapy) and routine SUPPORTIVE drugs (e.g. pain medications, steroids, compounded products, anti-coagulants, anti-nausea drugs). Some drug access navigators focus just on the drugs related to your cancer treatment, while others can discuss and investigate options on any prescribed drugs that might be posing a burden during cancer treatment.
Examples of how an Oncology Drug Access Navigator might help:
- Conduct 3-way calls with you to your insurer to verify if a drug is listed on your plan
- Prepare prior authorization forms for the prescribing physician
- Submit and track prior authorization requests
- Coordinating renewals of drug funding approvals to ensure treatment continuity
- Assist with applications to the provincial public drug plan
- Investigate funding options for new drugs or drugs for rare cancers
- Assist with applications to the Special Access Programme for non-marketed drugs
- Coordinate temporary drug supplies or applications with pharmaceutical-sponsored programs
- Assist physicians with appeals when negative coverage decisions are made
What They DON’T DO
An oncology drug access navigator does not proceed with any funding request or investigation into a person’s drug plan without that person’s CONSENT. A drug access navigator may investigate general availability options for a drug ahead of treatment planning upon a physician’s request. This might include seeing if a pharmaceutical company is offering an early release program or if an insurer has added a drug to their overall plan formulary.
The assistance of an oncology drug access navigator is limited to prescribed drugs or over-the-counter drugs (e.g. acetaminophen) that are approved to be sold in Canada and that are necessary to the patient’s treatment plan. As a rule, oncology drug access navigators do not investigate funding options for new drugs still under consideration by Health Canada.
In cases where a drug is not under review and is not available in Canada (i.e. the manufacturer has not planned to sell it in Canada), the oncology drug access navigator may help the prescribing physician or pharmacist with an application to Health Canada’s Special Access Programme. The navigator does not help find the drug or resources to pay for the drug in these cases. They may simply coordinate the paperwork to facilitate the process.
Some oncology drug access navigators may assist with drug funding issues that arise in the context of on-site clinical trials. This usually pertains to prescription drugs needed during the trial but not covered by the trial sponsor. An oncology drug access navigator may also get involved near the end of a clinical trial to help the patient find a permanent source of funding for a drug. In these cases, the navigator is contacted for help by the clinical trial nurse or coordinator. Oncology drug access navigators do not help with locating discretionary funds for those who wish to travel out of province for clinical trials or experimental treatment. For more information on these assistance programs, please refer to your local provincial government department of health website.
Oncology drug access navigators do not investigate funding for alternative medicines, herbal products, supplements or other treatments that fall outside current cancer clinical treatment guidelines. Some oncology drug access navigators may investigate coverage options for cannabis products prescribed by the treating oncologist, but their work is limited to helping with applications for coverage to a person’s drug plan. It should be noted that although legalized for sale in Canada, not all drug plans cover the cost of cannabis for medicinal purposes. Oncology drug access navigators do not advise on the use or availability of cannabis products, nor do they work directly with mail order programs or dispensaries.