Glossary of Terms
The Oncology Drug Access Navigators of Ontario is a network of drug access navigators that assist patients in getting the medication they need for their cancer treatment.
A Drug Access Navigator is a healthcare professional that helps patients access the medications they need for their cancer treatment.
The Trillium Drug Program. Public drug coverage in Ontario for those 25-65 years of age.
Cancer Care Ontario is an agency of the provincial Government of Ontario that is responsible for improving cancer services. It was created by the Ontario government in April 1995.
A “biosimilar”, previously known in Canada as Subsequent Entry Biologics (SEBs), is a drug demonstrated to be highly similar to a biologic drug that was already authorized for sale. Biosimilars are not the same as generic drugs.
The Ontario Drug Benefit is the government payer for public drug coverage in Ontario. Over 4400 drugs are covered by ODB.
The deductible is the amount of a covered expense that you pay before your insurance makes any payments.
For Trillium, this is 4% of net household income. For example, if you net household income is $50,000, then 4% (50,000 x 0.04) = $2000 per year. This is divided into 1 payment per quarter or $500 every 3 months.
This is drug supply provided to a patient as a temporary measure until their public or private payment method starts to cover the drug. Bridging supply is usually provided by a drug manufacturer.
The Exceptional Access Program. This department of the Ontario Ministry of Health approves drugs to be covered by the Ontario Drug Benefit (ODB). They’re typically specialized or expensive medications.
Drug coverage through the government. This is automatic for any Ontarian resident with OHIP under 25 and over 65. For those 25-65, to have public coverage you need to apply to the Trillium Drug Program or qualify for Ontario Works / Ontario Disability Support Program.
Insurance through your employer or purchased on your own that provides different health benefits. This can include physiotherapy, life insurance and drug coverage.
When you are covered by more than 1 insurance plan. If your primary plan doesn’t pay the full amount of an expense, you can submit a claim to the other plan for the balance. In this way, you can receive up to 100% of your expense.
Private plans can “require” or provide an incentive to patients to purchase their drugs from a preferred supplier in order for the claim to be reimbursed. Pharmacies usually agree to certain services, competitive dispensing fees and drug prices for private plans that select them as preferred providers.
The Ontario Health Insurance Plan is the Ontario health plan. This involves all aspects of your healthcare; from visiting a doctor to medical tests and surgery.
This is the Drug Identification Number. It is assigned by Health Canada for any drug approved for use in Canada.
Stands for Patient Support Program. These are programs provided by drug manufacturers to help those on their drug. They can range from offering financial assistance to nursing phone support to adherence reminders and home delivery.
The Special Access Program a program through Health Canada to request access to drugs that are not yet approved for use in Canada.
Stands for pan-Canadian Oncology Drug Review. It is a federal evidence-based, cancer drug review process.
The formulary is a list of the drugs that are covered under the drug plan. Each public and private drug plan has its own formulary and each hospital has its own formulary. Some drugs listed on the formulary are classified as limited use/conditional listing and are only eligible for coverage under certain conditions.
Stands for Limited Use Code. These products are listed in the Formulary with specific clinical criteria/conditions for use.
Stands for Notice of Compliance. This is a notice that Health Canada provides to manufacturers authorizing them to market a drug, sometimes under specific conditions.
The distribution of medication to patients without the financial means to pay for the medication on their own. For example, the drug manufacturer supplies the drug at no charge.
Members of an insurance plan may be required to pay a fee for each prescription. For example, if an insurance plan requires a copay amount of 20%, the plan member will only be reimbursed for 80% of the claim amount.
Deferred payment insurance plan require a plan member to pay the full cost of the prescription at the pharmacy. Your insurance will then reimburse you after your claim has been approved and processed.
The NDFP is administered by Cancer Care Ontario on behalf of the Ministry of Health and Long-Term Care, and provides about 75% of the overall funding for intravenous cancer drugs. NDFP funding is for new and approved intravenous cancer drugs administered in hospitals.