Pharmacist, Provincial Drug Reimbursement Programs

Ontario Health • Toronto, ON

13d • Onsite

About The Position

The Provincial Drug Reimbursement Programs (PDRP) administers several cancer drug and service case adjudication and funding programs on behalf of the Ontario Ministry of Health (ministry). As part of the Clinical Institutes and Quality Programs (CIQP) 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. As part of this role, the Pharmacist is seen as the subject matter expert in a highly complex or technical field, and consults with stakeholders in a strategic and advisory capacity. The Pharmacist primarily supports the operations of Ontario Health’s three main population-based cancer drug reimbursement programs within PDRP. The annual expenditure paid out to hospitals for eligible claims is $700M and growing which corresponds to over 26,000 treatments and 2500 enrolments per month. The New Drug Funding Program (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. A robust pipeline of new cancer therapies mandates careful planning in order to support their introduction and ongoing public funding. The Pharmacist’s primary responsibility will be to lead the clinical content development and implementation of new cancer drug funding policies. This involves collaborative work with internal stakeholders within our unit, across other Ontario Health units as well as with our Ontario Cancer Leads (OCLs), their respective disease site drug advisory committees, other Ontario Health-affiliated clinicians, the ministry, and other provincial cancer agencies. The Pharmacist will work with other Ontario Health team members (specialists/analysts, other pharmacists, managers, product management team members) to create and review funding and adjudication rules within eClaims, Ontario Health’s claims adjudication system. This permits real-time notification to hospitals of enrolment and treatment claim eligibility. The Pharmacist is the primary point of contact for adjudication-related issues for internal and external stakeholders and supports a team of Reimbursement Analysts who are the primary liaisons to over 80 hospitals/cancer centres. Overall, this Pharmacist will support the ongoing funding of cancer therapies and PDRP’s goal of making evidence-based, cost-effective treatments available to patients as quickly as possible. The Pharmacist will also support other PDRP staff with the 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. The Pharmacist may provide secretariat support to the Ontario Steering Committee for Cancer Drugs (OSCCD) which is an expert advisory committee to the ministry on cancer drug reimbursement issues. The Pharmacist may also be asked to provide clinical expertise on submissions/items brought forth to the committee for review. The Pharmacist may provide 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.

Requirements

• A degree in Pharmacy and registration (Part A – can provide patient care) with the Ontario College of Pharmacists is required.
• A minimum of three years of experience in oncology, either as a clinical pharmacist or in drug benefit management (or equivalent experience), is required.
• Analytical Thinking & Problem Solving – The role requires an in-depth knowledge of the cancer 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.
• 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.

Nice To Haves

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

Responsibilities

• Lead the timely implementation of new drug funding policies within NDFP, EBP and HCTFP.
• Develop, revise and implement policies, procedures and quality improvement initiatives related to program operations.
• Support the Reimbursement Analysts and oversee the review of all cancer drug funding requests within population-based funding programs (NDFP, EBP, HCTFP).
• Assess prior approval requests submitted by hospitals along with appeals and/or resubmissions.
• Support the communication strategy of the unit by liaising with PDRP staff/management, OH communications and ministry communications/public affairs on urgent or contentious requests.
• Support the assessment of systemic treatment clinical trials to ensure alignment with cancer drug funding policies through Ontario Public Drug Programs.
• Provide secretariat support to OSCCD, including providing clinical expertise on submissions/items brought forth to the committee for review.
• Provide cross-coverage across PDRP as required including operational support for CBCRP and subject matter expertise pertaining to the management of oncology drug shortages.
• Other duties as assigned.

Benefits

• Comprehensive health coverage from day one, with fully paid medical, dental, and vision benefits to support you and your family’s health
• Flexible health care or wellness spending accounts, plus an inclusive program to support your overall well-being
• A premium defined benefit pension plan, ensuring long-term financial security
• Competitive vacation entitlement that encourages time to rest and recharge
• Three personal days and two float days annually, providing added flexibility to support work-life balance, in addition to vacation days
• Ongoing learning and career development opportunities designed to help you grow, advance, and thrive in your profession

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level