Pharmacist, Reimbursement

What Ontario Health offers:

Achieving your career goals is a priority to us. Benefits of working at Ontario Health may include the following based on employment type:

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:

• Strategic planning

• Subject matter advice

• Stakeholder engagement

Here is what you will be doing:

• The PDRP Pharmacist will be a subject matter expert for the program operations, case adjudication and issues management for PDRP funding programs.

• The Pharmacist will work collaboratively with internal team members, disease site specific clinical leads and, other clinical expert reviewers and the ministry to lead the timely implementation of new drug funding policies within NDFP, EBP, HCTFP, and for cell and gene therapies.

• The Pharmacist supports the assessment of systemic treatment clinical trials to ensure alignment with cancer drug funding policies through Ontario Public Drug Programs.

• The Pharmacist works with PDRP's managers and other pharmacist(s)/program staff in the development, revision and implementation of policies, procedures and quality improvement initiatives related to program operations.

• The Pharmacist independently, and in collaboration with other pharmacist(s) and management in PDRP supports the Reimbursement Specialists and oversees the review of all funding requests within our funding programs (NDFP, EBP, HCTFP, OOC, CAR T-cell). This includes assessing prior approval requests submitted by hospitals along with appeals and/or resubmissions which are all time-sensitive and potentially contentious in nature. This may require input from our OCLs, other clinical expert reviewers and the ministry.

• The Pharmacist supports the communication strategy of the unit by liaising with PDRP staff/management, OH communications and ministry communications/public affairs on urgent or contentious requests, and supports messaging for internal/external inquiries by providing subject matter expertise.

Here is what you will need to be successful:

Education and Experience:

• Degree in Pharmacy and registration with the Ontario College of Pharmacists is required.

• A minimum of three years of clinical pharmacy or drug benefit management experience (or equivalent experience), is required.

• Completion of a hospital pharmacy residency would be an asset.

Knowledge and Skills:

• Analytical Thinking & Problem Solving - The role requires an in-depth knowledge of the drug funding landscape in Ontario along with the requisite skills to complete a thorough assessment of a patient's clinical history and proposed treatment plan(s).

• An understanding of, and experience with the application of, evidence-informed practice is required. Experience in critical appraisal and literature review is an asset.

• A detailed understanding of cancer drug reimbursement in Ontario is strongly preferred.

• An understanding of Ontario public drug reimbursement programs and knowledge of public healthcare systems is essential.

• Excellent written and oral communication skills, including the capacity to engage, and a demonstrated ability to build relationships among clinicians and other stakeholders is required.

• Ability to multi-task and prioritize assignments to meet deadlines.

• Demonstrated ability to work independently and effectively in a team environment.

• Ability to pivot quickly and be responsive to the ever-changing needs of the health care system to support funding requests for cancer patients.

Location: Ontario (currently hybrid; subject to change)