Guide to Accessing TKIs for CML Patients in Quebec
This guide provides comprehensive information on how Chronic Myeloid Leukemia (CML) patients in Quebec can access Tyrosine Kinase Inhibitors (TKIs), including Asciminib, Nilotinib, Dasatinib, Imatinib, Bosutinib, and Ponatinib. TKIs are vital for managing CML, and this guide outlines the pathways through employer-sponsored drug benefit programs, the Régie de l'assurance maladie du Québec (RAMQ) program, and pharmaceutical company patient assistance programs.
1. Accessing TKIs Through Employer-Sponsored Drug Benefit Programs
If you are covered by an employer-sponsored health insurance plan, you may be able to access TKIs through this program.
Steps to access TKIs through employer-sponsored plans:
1. Review your insurance policy to confirm coverage for the prescribed TKI.
2. Consult with your oncologist or hematologist for a prescription and necessary documentation/referral.
3. Submit a Special Authorization request to your insurance provider, along with supporting medical documents.
2. Accessing TKIs Through Pharmaceutical Company Programs
In some case, employer sponsored, or private drug plans may have high co-pays. Co-Pays are the amount you pay after the deduction. In that case, pharmaceutical companies often sponsor patient support programs, administered by third parties such as Innomar, Bayshore, or McKesson, to help patients access TKIs.
The steps to access the programs are essentially the same as obtaining coverage from your private plan/ employer drug plan:
1. Consult with your oncologist or hematologist for a prescription and necessary documentation/referral.
2. Submit a Special Authorization request to your insurance provider, along with supporting medical documents.
Below is the list of Patient Support Programs for non-generic TKI’s
1. Asciminib (Scemblix): Mfg. Novartis
Patient support program Sentia – PSP contact information:
Phone: 1-855-736-8421
Fax: 1-866-636-8421
Email: psp@sentia-exp.ca
2. Nilotinib (Tasigna): Mfg. Novartis
Patient support program Sentia – PSP contact information:
Phone: 1-855-736-8421
Fax: 1-866-636-8421
Email: psp@sentia-exp.ca
3. Bosutinib (Bosulif): Pfizer Liaison (1-844-616-6888)
4. Ponatinib (Iclusig): Paladin Labs Distribution Program for patients. Contact 1.877.318.4462 or Email: PalSupport@bayshore.ca for support
3. Accessing TKIs Through RAMQ
The Régie de l’assurance maladie du Québec (RAMQ) program offers coverage for prescription drugs, including TKIs, for individuals who are not covered by a private insurance plan. Those not covered through private insurance plans may be retired, self- insured, or unemployed.
Steps to access TKIs through RAMQ:
1. Verify that the prescribed TKI is listed in the RAMQ’s List of Medications.
2. Work with your healthcare provider to submit any required forms for Special Authorization, if applicable.
3. Ensure all necessary documentation is complete for a smooth approval process.
4.Go to your local pharmacy to deposit your prescription. The pharmacist will open a file and coordinate the information with RAMQ to provide you with the medication.
4. Generic Drugs
There are currently two generic TKI’s on the Market in Canada. These drugs may be covered through your private insurance/employer sponsored drug plan and RAMQ, but they DO NOT have a pharmaceutical company sponsored support program.
1. Gleevec (Imatinib): Offered by Apotex or Teva,
2. Dasatinib (Sprycel): Offered by Teva Canada Limited, Appotex Inc. and Taro Pharmaceuticals
5. Additional Resources
Here are some key resources to help you navigate access to TKIs:
1. CML Society of Canada: Offers support and information for CML patients. Visit www.cmlsociety.org.
2. RAMQ Public Prescription Drug Insurance Plan: Provides coverage details and assistance. Visit www.ramq.gouv.qc.ca.
Conclusion:
Accessing TKIs in Quebec involves multiple pathways, and this guide is designed to help you understand your options. Whether through private insurance, RAMQ, or pharmaceutical assistance programs, there are resources available to support you. Consult your healthcare provider for personalized advice and assistance.