Drug coverage and access

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Myeloma Drug Access Navigator tool

Over the last 15 years, treatment options for myeloma have increased significantly with the addition of novel, targeted agents and drugs. However, in Canada, availability for these treatments, as well as drug coverage, varies from province to province. The process of finding this information can be confusing and sometimes overwhelming.

To simplify the provincial drug coverage information you need, Myeloma Canada has designed the Myeloma Drug Access Navigator tool.

See, at a glance, the drugs that are available and covered in each province and territory.

If you’re looking for a drug that’s privately funded (through private or group insurance plans), consult your insurance provider for more information.

Alternatively, to search for drug treatments that are available through clinical trials please visit Myeloma Canada’s Clinical Trials page.

For drugs available through compassionate access by the manufacturer, talk to your doctor or nurse practitioner for more information, or call Myeloma Canada, toll-free at 1-888-798-5771.

Paying for cancer drugs in Canada

In Canada, there are 4 ways that myeloma drug costs may be covered:

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The drug is on the approved list for your provincial or territorial government health insurance plan or public drug benefit program.
Since drug coverage varies from one province to the next, it’s important to know your eligibility for health insurance coverage.

Drugs provided or made available through cancer care centres can also vary by province. To learn about your options, speak with your cancer team’s social worker, your pharmacist, or call your provincial Ministry of Health.

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Your private insurance/drug plan will pay for the drug (many private plans also have formularies or lists of covered drugs).
If you have private health insurance or a drug plan, carefully review your benefits. Ask your doctor what drugs you may need in the future, and check to see if your plan covers them.

Some private insurance plans require that you pay up front and then apply for reimbursement. Ask your insurance company to allow your pharmacy to send the bill directly to them.

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The drug manufacturer will pay for all or part of the drug (if you meet certain financial eligibility criteria).
Some pharmaceutical companies have free services to help you search for coverage of specific drugs. In some cases, they may even supply you with the medication itself. Speak with your cancer care team or search online to see if you are eligible for such a program (often called a “compassionate access” program).

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You pay for the drug yourself (out-of-pocket cost). What if I am denied coverage?
If you are refused coverage of a medication you need, appeal. Sometimes the insurance company may reverse the decision.

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Additional resources to help you navigate the healthcare system