Drug Access Canada is a registered non-profit corporation. We strive to create better access to medication for Canadians. This primarily consists of providing training, resources and education to healthcare providers as well as advocating for improvement to drug coverage through public and private insurance. Drug Access Canada also advocates for the role of the Drug Access Navigator in Canadian healthcare and the efficiency and improved satisfaction this role provides.
We provide a network for healthcare providers involved in drug access to reach each other to solve problems and learn best practices.
This process is much more complex than outlined here but the basic steps are:
Health Canada will review the drug effect and safety. If approved, the drug will be marketable in Canada and given a Drug Identifical Number (DIN).
Then, a Health Technology Assessment (HTA) will take place. This is done by the Canadian Agency for Drugs and Technologies in Health (CADTH) or the Institut national d'excellence en santé et services sociaux (INESSS) for Quebec. They will assess value of the treatment.
If approved, pricing negotiations will take place. This is done through the pan-Canadian Pharmaceutical Alliance (pCPA). Pricing is negotiated between the drug manufacturer and government.
With pricing complete, the drug will be approved by the provinces next and become a public benefit.
Drugs in Canada are funded through a patchwork of different methods.
- Drugs provided in hospital are paid for by the hospital at no cost to the patient.
- Drugs taken outside of hospital are the responsibility of the patient. This can include public drug coverage through provincial or federal plans or through private health insurance. Provinces have their own systems for covering patients. Private health insurance is often obtained through an employer or can be purchased on its own by a patient like travel insurance.
- Sometimes drugs are paid for out of pocket. This is where a patient pays out the cost of the drug themselves and may be due to not having public / private drug insurance or for a drug not paid for by the government such as off label use.
A Drug Access Navigator, or DAN, is a healthcare professional who’s focus is to connect a patient with a drug / treatment. This can include assisting with applications for public / private insurance, enrolling patients into various programs to help with cost as well other tasks like genomic testing. The DAN takes the burden of paperwork, applications and appeals away from the patient as much as possible so they can focus on their treatment.
Currently DANs are mostly found in cancer clinics but are increasingly found in other diseases like Multiple Sclerosis and Cystic Fibrosis.
The Drug Access Navigator can also be known by other titles like Drug Access Facilitator or Medication Reimbursement Specialist.
A pharmaceutical manufacturer's patient support program, or PSP, is a service to provide features for patients on specific medications. They can offer things like bridging medication where a drug is provided free until there is public or private coverage for it. They may provide financial assistance to cover extra costs of a medication, like an insurance copayment. They may also assist patients with private infusion of an IV drug, home delivery of an oral drug and other services like nursing drug adherance reminders.
If you have specific inquiries about accessing a medication, you should:
- For cancer related medications, see if your treatment clinic has a Drug Access Navigator that can assess your situation and see what opportunities exist to help.
- For Ontario cancer patient, you can use www.odano.ca for helpful information
- For non-cancer patients, check with your prescriber or pharmacist for guidance on what options may be available to assist you.
Government health insurance plans give you access to basic medical services. You may also need private insurance to pay for things that government plans don’t fully cover.
These extended health plans may cover costs for:
- prescription medications
- dental care
- ambulance services
- prescription eyeglasses
The Special Access Programme (SAP) provides access to drugs that have not been approved for use by Health Canada. These are drugs for treating patients with serious or life-threatening conditions when conventional therapies have failed, are unsuitable, or unavailable. The SAP authorizes a manufacturer to sell a drug that cannot otherwise be sold or distributed in Canada. Drugs considered for release by the SAP include pharmaceutical, biologic, and radio-pharmaceutical products not approved for sale in Canada.
To see if a drug is available through the Special Access Program, you may want to reach out to the drug manufacturer directly.
You can learn more about SAP here: