PATIENT ASSISTANCE PROGRAMS

1 PATIENT ASSISTANCE PROGRAMS Definitions Class I Reimbursed for active cancer or approved treatment or approved indication only Restricted Funding Reimbursement for approved indications only. Completion of the BC Cancer Compassionate Access Program Application (formerly Undesignated Indication Form) is necessary to provide the appropriate clinical information for each PATIENT The PATIENT ASSISTANCE Program chart is a general reference on the available PROGRAMS offered by pharmaceutical manufacturers to help patients access specific drug therapies. Inclusion in the chart does not imply BC Cancer endorsement of any drug therapy that is not approved on the BC Cancer Benefit Drug List. Care has been taken to ensure accuracy of information; however it is not intended to replace specific information as provided by the manufacturer. Since program requirements are constantly evolving, it is advised that this chart not be used as a sole source of information.

2 If you are aware of PATIENT ASSISTANCE PROGRAMS updates that you would like to see added to this chart, please contact: H:\Pharm-prov\Provincial DI Coordinator\Protocol\ PATIENT ASSISTANCE PROGRAMS 1/36 Home injection PROGRAMS DRUG SUPPLIER BC CANCER BENEFIT CLASS PROGRAM INFORMATION Buserelin (SUPREFACT ) Sanofi-Aventis Class I SUPREFACT Home Injection Program Medicum PATIENT ASSISTANCE Program Tel: 1-877-787-3228 Fax: 1-877-787-3376 ASSISTANCE offered: Home delivery (weigh bills provided to pharmacies to ship buserelin and charge to the SUPREFACT Community Care and Home Injection Program) Home injection service (free of charge) Degarelix (FIRMAGON ) Ferring Class I Coverdale Clinics - Firmagon Injection Program Tel: 1-866-210-0399 Fax: 1-866-793-5500 ASSISTANCE offered: Ten fully operational clinics across BC Physician enrolls PATIENT on the program for administration at a nearby clinic.

3 Goserelin (ZOLADEX LA) TerSera Class I ZOLADEX Home Injection/Clinic PATIENT Support Program Tel: 1-866-733-7511 Fax: 1-866-733-7514 ASSISTANCE offered: Program applies to the Zoladex LA quarterly injection Home or clinic anywhere in BC, free of charge Snowbird Program for out of country injections Home delivery to patients (waybills provided) If you are aware of PATIENT ASSISTANCE PROGRAMS updates that you would like to see added to this chart, please contact: H:\Pharm-prov\Provincial DI Coordinator\Protocol\ PATIENT ASSISTANCE PROGRAMS 2/36 DRUG SUPPLIER BC CANCER BENEFIT CLASS PROGRAM INFORMATION Lanreotide (SOMATULINE ) Ipsen Class I or Restricted Funding based on indication IPSEN CARES Program Tel: 1-855-215-2288 Fax: 1-844-686-0661 ASSISTANCE offered: Financial ASSISTANCE is available to all patients with or without third party insurance Compassionate supply available, based on financial need Home delivery service available Home injection service (free of charge) Leuprolide (ELIGARD ) Sanofi-Aventis Class I ELIGARD Home Injection Program Tel: 1-877-787-3228 Fax: 1-877-787-3376 ASSISTANCE offered: Home delivery (waybills provided to pharmacies to ship leuprolide and charge to the ELIGARD Community Care and Home Injection Program) Home injection service (free of charge) Leuprolide (LUPRON ) AbbVie Class I AbbVie Care Support Program Tel: 1-844-458-7766 Fax: 1-844-258-7766 ASSISTANCE offered.

4 Help for patients to obtain third party coverage Financial ASSISTANCE may be provided Home injection service (free of charge) Home delivery (pre-paid waybills provided to pharmacies to ship leuprolide to PATIENT s home if they are immobile or live in rural areas) If you are aware of PATIENT ASSISTANCE PROGRAMS updates that you would like to see added to this chart, please contact: H:\Pharm-prov\Provincial DI Coordinator\Protocol\ PATIENT ASSISTANCE PROGRAMS 3/36 DRUG SUPPLIER BC CANCER BENEFIT CLASS PROGRAM INFORMATION Octreotide (SANDOSTATIN ) Novartis Pharmaceuticals Class I Access SANDOSTATIN LAR Tel: 1-866-281-4688 Fax: 1-866-281-4689 ASSISTANCE offered: Help for patients to obtain third party coverage Financial ASSISTANCE may be provided Home injection service (free of charge) If you are aware of PATIENT ASSISTANCE PROGRAMS updates that you would like to see added to this chart, please contact: H:\Pharm-prov\Provincial DI Coordinator\Protocol\ PATIENT ASSISTANCE PROGRAMS 4/36 Supportive care medications DRUG SUPPLIER BC CANCER BENEFIT CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Aprepitant (EMEND ) Merck Funded by BC Cancer for approved indications for BC Cancer inpatient use only.

5 Merck Canada PATIENT ASSISTANCE Program Tel: 1-866-906-3725 Fax: 1-800-754-0151 ASSISTANCE offered: Compassionate supply is available to patients without third party insurance coverage Once certain criteria are met ( proof of low income) medication is delivered to prescriber s office or to a designated pharmacy to dispense and for PATIENT pick up PharmaCare Special Authority required. Dalteparin (FRAGMIN ) Pfizer Funded by BC Cancer for approved indications for BC Cancer inpatient use only. Fragmin First Dose Program Tel: 1-800-563-3274 Fax: 1-855-874-9069 ASSISTANCE offered: Sample card allows for: o treatment doses (5 free syringes) o prophylactic doses (10 free syringes) Fragmin PATIENT ASSISTANCE Card: o Financial ASSISTANCE is available to all patients who have third party insurance coverage but may need help with the co-pay PharmaCare Special Authority required.

6 If you are aware of PATIENT ASSISTANCE PROGRAMS updates that you would like to see added to this chart, please contact: H:\Pharm-prov\Provincial DI Coordinator\Protocol\ PATIENT ASSISTANCE PROGRAMS 5/36 DRUG SUPPLIER BC CANCER BENEFIT CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Darbepoetin (ARANESP ) Amgen Not funded by BC Cancer VICTORY Program Tel: 1-888-706-4717 Fax: 1-888-987-2201 ASSISTANCE offered: Financial ASSISTANCE is available to all patients who have third party insurance coverage but may need help with the co-pay Darbepoetin will be shipped by Victory program to a designated pharmacy Program to be initiated before PATIENT goes to pharmacy Not required Eltrombopag (REVOLADE ) Novartis Not funded by BC Cancer inReach PATIENT Support Program Tel: 1-888-475-4255 Fax: 1-888-475-3291 ASSISTANCE offered: Financial ASSISTANCE is available to patients with or without third party insurance.

7 patients may be asked to co-pay based on household income. PharmaCare Special Authority required. If you are aware of PATIENT ASSISTANCE PROGRAMS updates that you would like to see added to this chart, please contact: H:\Pharm-prov\Provincial DI Coordinator\Protocol\ PATIENT ASSISTANCE PROGRAMS 6/36 DRUG SUPPLIER BC CANCER BENEFIT CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Epoetin Alfa (EPREX ) Janssen Not funded by BC Cancer SPECTRUM Support Program for Eprex Tel: 1-877-793-7739 Fax: 1-888-298-8854 ASSISTANCE offered: Financial ASSISTANCE is available to all patients who have third party insurance coverage but may need help with the co-pay A compassionate supply is available to patients without third party insurance coverage, based on financial needs SPECTRUM program coordinates delivery with patients preferred pharmacy Initial self injection training with Nurse available in most regions.

8 SPECTRUM program will coordinate nurse home visit with PATIENT Not required If you are aware of PATIENT ASSISTANCE PROGRAMS updates that you would like to see added to this chart, please contact: H:\Pharm-prov\Provincial DI Coordinator\Protocol\ PATIENT ASSISTANCE PROGRAMS 7/36 DRUG SUPPLIER BC CANCER BENEFIT CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Filgrastim (GRASTOFIL ) Apotex Funded by BC Cancer for approved indications for inpatient use only. Apobiologix ANSWERS PATIENT Support Program Tel: 1-866-276-1664 Fax: 1-866-772-1458 ASSISTANCE offered: Financial ASSISTANCE is available to patients with or without third party insurance coverage Co-pay ASSISTANCE available Program needs to be initiated and PharmaCare approval established before PATIENT goes to the pharmacy PharmaCare Special Authority required. Filgrastim (NEUPOGEN ) Amgen Funded by BC Cancer for approved indications for inpatient use only.

9 VICTORY Program Tel: 1-888-706-4717 Fax: 1-888-987-2201 ASSISTANCE offered: Financial ASSISTANCE is available to all patients who have third party insurance coverage but may need help with the co-pay Victory Program will assist with the co-pay based on financial need and Fair PharmaCare deductible for each PATIENT Program needs to be initiated and PharmaCare approval established before PATIENT goes to the pharmacy PharmaCare Special Authority required. If you are aware of PATIENT ASSISTANCE PROGRAMS updates that you would like to see added to this chart, please contact: H:\Pharm-prov\Provincial DI Coordinator\Protocol\ PATIENT ASSISTANCE PROGRAMS 8/36 DRUG SUPPLIER BC CANCER BENEFIT CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Pegfilgrastim (NEULASTA ) Amgen Not funded by BC Cancer VICTORY Program Tel: 1-888-706-4717 Fax: 1-888-987-2201 ASSISTANCE offered.

10 Financial ASSISTANCE is available to all patients who have third party insurance coverage but may need help with the co-pay Compassionate supply will be shipped by Victory program to a designated pharmacy If PATIENT is prescribed NEULASTA and has no third party coverage, they will be offered NEUPOGEN Program to be initiated before PATIENT goes to pharmacy Not required Posaconazole (POSANOL ) Merck Canada Not funded by BC Cancer Merck Care Oncology Tel: 1-877-494-0454 Fax: 1-877-656-0686 ASSISTANCE offered: Financial ASSISTANCE is available to eligible patients with third party insurance coverage but may need help with the co-pay Compassionate supply available Not required If you are aware of PATIENT ASSISTANCE PROGRAMS updates that you would like to see added to this chart, please contact: H:\Pharm-prov\Provincial DI Coordinator\Protocol\ PATIENT ASSISTANCE PROGRAMS 9/36 DRUG SUPPLIER BC CANCER BENEFIT CLASS PROGRAM INFORMATION PHARMACARE SPECIAL AUTHORITY Valacyclovir (VALTREX ) GlaxoSmithKline Not funded by BC Cancer VALTREX PATIENT Assist Program Tel: 1-844-794-3577 Web: ASSISTANCE offered: The VALTREX PATIENT Assist Program will cover up to the difference between the out of pocket amount of branded VALTREX (valacyclovir hydrochloride) versus the out of pocket amount a PATIENT would have paid based on the average generic drug price.