Cancer drug cost in Ontario, Canada

Posted by waiting84 @waiting84, Sep 28, 2023

Hi,
I have been a member for few months but had not posted anything. But this forum has given me lot of information. I thank everyone who is taking their time to help each other.

So I'm in Ontario, Canada. My wife is a stage 4 pancreatic cancer patient. She went 12 Rounds of FOLFIRINOX. Now the oncologist wants to start Gemcitabine + Abraxane. We were told that Abraxane is not fully covered by the provincial drug plan. Anyone is on Abraxane and getting treatment in Ontario.

Interested in more discussions like this? Go to the Pancreatic Cancer Support Group.

I'm not in Canada, but I was curious to see what I could find out. I'm assuming you've researched on the internet as well. There doesn't seem to be a clear way to figure out how much Abraxane costs as a private-pay drug in Ontario, or at least I couldn't find anything. However, I did find this site:
https://www.cancercareontario.ca/en/cancer-treatments/chemotherapy/funding-reimbursement/drug-funding-faqs

Have you seen this site? This particular link lists lots of procedural FAQs on how drugs get approved for the provincial formulary and what people do if they have a medication that isn't covered. Click on the Drugs link at the top of the page, and that'll get you into the formulary list. Search for Abraxane, and it'll come up under its generic name, nab-PACLitaxel. There is a patient info sheet dated 2020, but I can't tell whether that's any sign that Abraxane is approved for coverage in Ontario. There is also a link at the top for Funding and Reimbursement which has some info on seeking coverage for a drug. Did your wife's oncology practice provide any pricing for you? Are they willing to file an appeal or help you file one? I'll be interested to see if another poster chimes in from Ontario with definitive pricing info for you.

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The manufacturer (Bristol Myers Squibb / "BMS") has a program (at least in the USA) that offers Abraxane free to patients below a certain income threshold. There's some paperwork involved (application forms and tax returns) that took time to complete, but it was manageable.

The same program might be available in Canada -- be sure to ask.

If your wife has a genetic mutation like ATM, it might be worth asking if it's practical and useful to add cisplatin to the drug mix. I've had a pretty good response to the triplet combo. (Better tolerated and more effective for me than the Folfirinox was.)

Update: You might be able to call the "Oncology Access and Reimbursement Support" line of BMS at 1-800-861-0048 or FAX them at 1-800-822-2496 to ask if they can provide you with information and send you their 7-page "Access Support" application form. The version I filled out had their document ID number "NO-US-2100752 09/21" in the bottom right corner. I'll send you the blank copy if I can find mine, but so far I've only found the completed version with my personal info on it.

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I just spotted some other stuff.

https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44106
Note that there's a little phrase up at the top that says New Drug Funding Program. So I searched for that.

https://www.cancercareontario.ca/en/Funding/New_Drug_Funding_Program
This site has a set of FAQs that talk in general terms about how drugs get covered, why some aren't covered and how to make an appeal. While it doesn't expressly say so, that would make me think Abraxane is covered under that program. I did note that the site says patients must meet eligibility criteria. Maybe that's the issue? Anyway, I hope a little of this info helps.

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Thanks for all your replies. I too found those links. As per eligibility criteria, our oncologist said we are not eligible since she already had FOLFIRINOX as first line treatment.

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@markymarkfl

The manufacturer (Bristol Myers Squibb / "BMS") has a program (at least in the USA) that offers Abraxane free to patients below a certain income threshold. There's some paperwork involved (application forms and tax returns) that took time to complete, but it was manageable.

The same program might be available in Canada -- be sure to ask.

If your wife has a genetic mutation like ATM, it might be worth asking if it's practical and useful to add cisplatin to the drug mix. I've had a pretty good response to the triplet combo. (Better tolerated and more effective for me than the Folfirinox was.)

Update: You might be able to call the "Oncology Access and Reimbursement Support" line of BMS at 1-800-861-0048 or FAX them at 1-800-822-2496 to ask if they can provide you with information and send you their 7-page "Access Support" application form. The version I filled out had their document ID number "NO-US-2100752 09/21" in the bottom right corner. I'll send you the blank copy if I can find mine, but so far I've only found the completed version with my personal info on it.

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Thanks. I really appreciate it

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@markymarkfl

The manufacturer (Bristol Myers Squibb / "BMS") has a program (at least in the USA) that offers Abraxane free to patients below a certain income threshold. There's some paperwork involved (application forms and tax returns) that took time to complete, but it was manageable.

The same program might be available in Canada -- be sure to ask.

If your wife has a genetic mutation like ATM, it might be worth asking if it's practical and useful to add cisplatin to the drug mix. I've had a pretty good response to the triplet combo. (Better tolerated and more effective for me than the Folfirinox was.)

Update: You might be able to call the "Oncology Access and Reimbursement Support" line of BMS at 1-800-861-0048 or FAX them at 1-800-822-2496 to ask if they can provide you with information and send you their 7-page "Access Support" application form. The version I filled out had their document ID number "NO-US-2100752 09/21" in the bottom right corner. I'll send you the blank copy if I can find mine, but so far I've only found the completed version with my personal info on it.

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My wife has PALB2 mutation. I asked about adding cisplatin ( I got that info from this forum). But he didn't want to do it. I will ask again

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@waiting84

Thanks for all your replies. I too found those links. As per eligibility criteria, our oncologist said we are not eligible since she already had FOLFIRINOX as first line treatment.

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So she isn't eligible for Gemzar/Abraxane as second line treatment? My oncologist (again, in the US) said that combo would likely be our second line treatment if/when the Folfirinox stops working for me. @markymarkfl is getting Gemzar/Abraxane as second line treatment as well. So I'm a little mystified by your MD's explanation.

If you can't get an appeal through, I'd definitely try the Bristol Myers Squibb option. You might also explore clinical trials.

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I think Folfirinox has been prioritized as the first-line go-to chemo for patients with better overall performance status (ability to tolerate it), but that doesn't mean it's always best. If I had started with Gem+Abrax+Cis 1.5 years ago, I might be cured instead of Stage-IV now.

If Gem+Abrax+/-Cis is not an approved option, then maybe they'll skip directly to some sort of clinical trial drug. The PALB2 mutation is related to "DNA Damage Repair" (as are BRCA and ATM, but don't ask me how!), and there might be some role for a PARP inhibitor, although approval for that in the USA seems limited to BRCA mutations only.

The ATM mutation is said to be platinum-sensitive, which is why my oncologist made sure it got added to the Gem/Abrax. Not sure if that applies for PALB2, but the Google results are interesting.

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@waiting84, also check to see if the drug cost is covered by the hospital's drug formulary since it will be administered in the hospital. I believe @krfinlayson @mmerry are pancreatic cancer members who are also Ontario residents.

You may also be interested in this related discussion:
- Anyone on Gemcitabine with Abraxane? How long? Effective?
https://connect.mayoclinic.org/discussion/gemcitabine-and-abraxane/

@waiting84 how are you and your wife doing?

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@colleenyoung

@waiting84, also check to see if the drug cost is covered by the hospital's drug formulary since it will be administered in the hospital. I believe @krfinlayson @mmerry are pancreatic cancer members who are also Ontario residents.

You may also be interested in this related discussion:
- Anyone on Gemcitabine with Abraxane? How long? Effective?
https://connect.mayoclinic.org/discussion/gemcitabine-and-abraxane/

@waiting84 how are you and your wife doing?

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So it turns out Abraxane is publicly funded when it's used as first line treatment. Since my wife already had FOLFIRINOX she is not eligible.

However there is something called 'Abraxane Access Program' where it covers 60%. We enrolled in this program.

Her first treatment is today. She is also getting a drain for her ascites. She is in agony, cannot eat anything but fluids.

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