The Provincial Drug Reimbursement Programs (PDRP) administers several cancer drug and case adjudication and funding programs on behalf of the Ontario Ministry of Health (ministry). As part of the Acute and Hospital-Based Care portfolio, PDRP provides timely access to high-cost cancer treatments and services, while ensuring the rational use of limited health resources.
Reporting to the Manager, Provincial Drug Reimbursement Programs, the Pharmacist is responsible for providing authoritative advice to internal and external stakeholders on their specific area of expertise. In this role, the PDRP Pharmacist will be a subject matter expert for the program operations, case adjudication and issues management as it pertains to all funding programs and policies. The pharmacist will be cross-trained to support the operations of the New Drug Funding Program (NDFP), High Cost Therapy Funding Program (HCTFP), Case-by-Case Review Program (CBCRP), CAR T-cell therapy program, Out-of-Country (OOC) program, gene therapy reviews, issues management, and other programs within PDRP.
The CBCRP considers funding requests for take-home and hospital-administered injectable cancer drugs for patients with rare cancers and/or clinical circumstances. Each individualized case request requires a detailed clinical workup, with input from clinical expert reviewers, followed by a funding recommendation to the Executive Officer, Ontario Public Drug Programs.
The NDFP provides coverage for standard treatment options and funds over 60 drugs for 150+ indications. The Evidence Building Program (EBP) provides time-limited funding for drugs/indications with emerging but incomplete evidence. The High Cost Therapy Funding Program (HCTFP) provides coverage for drugs with specialized administration requirements. Together, these programs flow more than $1B to hospitals for >26,000 eligible treatment claims and continues to grow.
The OOC program supports the Ministry of Health’s Out-of-Country Prior Approval program by providing case-by-case funding recommendations for cancer services to be received out of the country. The OOC Program helps patients access clinically appropriate and medically necessary cancer services that are either not performed in Ontario or cannot be obtained in Ontario without medically significant delay.
The CAR T-cell therapy program provides provincial oversight for the planning and delivery of CAR T-cell therapy services in Ontario as well as funding to hospitals for eligible cases. Each individualized enrolment requires a detailed clinical workup, with input from clinical expert reviewers when necessary, to ensure eligibility.
The Pharmacist will work with other Ontario Health team members (specialists/analysts, other pharmacists, managers, product management team members) to support implementation of new drug funding policies. This involves collaborative work with internal stakeholders within our unit, across other Ontario Health units as well as with our disease site specific clinical leads and their respective disease site drug advisory committees, other Ontario Health-affiliated clinicians, the ministry, and other provincial cancer agencies.
The Pharmacist may also support other PDRP staff with the following: 1) assessment of systemic treatment clinical trials to ensure that participation within the clinical trial is congruent with public cancer drug funding both within trial or used subsequent to trial; 2) implementation of new funding programs and policies; and 3) providing content knowledge related to the management of oncology drug shortages. This could include liaising with clinical experts and other provincial cancer agencies on developing conversation strategies and other risk mitigation measures.
Key areas of responsibility include:
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Strategic planning
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Subject matter advice
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Stakeholder engagement
