Page 75 - CUA Adv Prostate Ca Drug Acccess Listing

PATIENT ASSISTANCE PROGRAMS

Drug, Indication Program Name Contact Information Strength DIN Eligibility Criteria & Window Support Offered
Company
• Compassionate supply
Janssen Phone : 1-844-511-2616 may be available.
Abiraterone BioAdvance Fax : 1-855-629-7100
(Zytiga) mCRPC Patient Email : 250 mg PO 02371065 • Contact program • Financial assistance for
Janssen Inc. Assistance patients with or without
Program zytiga@bioadvancemail.ca private insurance may be
available.

Janssen Phone 1-844-511-2616 • Compassionate supply
Apalutamide BioAdvance Fax : 1-855-629-7100 may be available.
(Erleada) nmCRPC Patient Email : 60mg PO 02478374 • Contact program • Financial assistance for
Janssen Inc. Assistance erleada@bioadvancemail.c patients with or without
Program a private insurance may be
available.
DART: Dispensary: • Financial assistance for
Darolutamide Shoppers Drug Mart • Use on label per the patients may be available
Darolutamide Access & Specialty Health Network Canadian Product based on Financial Means
(Nubeqa) nmCRPC Reimbursement Phone: 1-833-955-DART 300mg PO 2496348 Monograph Test.
Bayer Inc. Touchpoint (3278) Open: 22-April-2020 • Reimbursement
Patient Support Fax: 1-877-208-4393 navigation support.
Program Email: info@dartsupport.ca Closed: No planned date • Bridging may be available.
• No compassionate supply
Denosumab Phone: 1-888-706-4717 available.
(Xgeva) Bone health Victory Program Fax: 1-833-884-5608 120 mg / 02368153 • Financial assistance for
Amgen mCRPC Email: 1.7 mL SC patients with or without
Canada Inc. private insurance may be
available.
• Compassionate supply
• All mCSPC, high-risk may be available.
nmCRPC, chemo naive
Enzalutamide Phone: 1-855-982-6348 mCRPC and post chemo • Financial assistance for
patients with or without
(Xtandi) mCSPC Xtandi Patient Fax: 1-855-982-6349 mCRPC
Astellas nmCRPC Assistance Email: 40 mg PO 02407329 • Program enrolment only private insurance may be
available.
Pharma mCRPC Program info@XTANDIassistancepr requires the completion of
Canada Inc. ogram.ca the XPAP form EN; • Reimbursement services,
XPAP form FR speciality pharmacy
services, nurse support
services.
• Patients with mCRPC who
have received and • Patients who meet criteria
Olaparib BRCAm or AstraZeneca Phone: 1-877-280-6208 progressed on NHA (new are eligible for drug free of
hormonal agent) in any
Fax: 1-877-280-6221
and Merck’s
(Lynparza) ATMm Oncology Email: 100 mg PO 02475200 setting charge
AstraZeneca 150 mg PO 02475219 • Program will screen for
Canada Inc. mCRPC Patient Support enrollment@azoncologyps • ECOG PS 0-2 insurance coverage
p.ca
Program
•
Identified with a germline
and/or somatic BRCA or • Co-pay assistance
ATM* (deleterious or
Page 38 | © Canadian Urological Association
v.01-SEP-2021