Breast Cancer Drug Financial Assistance Programme – XGEVA™

Overview

Bone is a common site of metastases from breast cancer. Bone metastases increase the risk of skeletal-related events (SREs), which are defined as spinal cord compression, surgery to the bone, pathological fracture and radiotherapy to the bone.1 In patients with breast cancer, 64% of those not treated with any bone-targeting agents went on to develop a SRE by 24 months.2 The mean number of SREs per patient per year is 3.7 in breast cancer.2 Seeing that SREs have a deleterious effect on patients, it is imperative that SRE prevention be integrated into the treatment plan of patients with advanced cancer.

Prescription drugs can become a big financial burden to many breast cancer patients. In this connection, the Breast Cancer Drugs Financial Assistance Programme is a joint effort between Hong Kong Breast Cancer Foundation (HKBCF) and pharmaceutical companies dedicated to helping breast cancer patients who are financially challenged by their medication costs.

 

1. About Breast Cancer Drug Financial Assistance Programme

Sponsorship Arrangement for XGEVATM

  • Maximum subsidy per patient: up to HK$15,600 per year
  • Quota: 
    100 patients from 1 June 2017 to 31 May 2018

 

Subject to the applicant’s financial status, HK$1,300 will be reimbursed for each XGEVA™ vial. Subsidy period for each applicant is 12 months. The maximum subsidy of HK $ 15,600 per period is calculated with reference to the number of XGEVATM vials consumed with proof of medication receipts.

Remarks:
Applicant should submit application early.

Only official medication receipts issued within 4 months of the application date are accepted.

Qualified applicant is required to re-submit proof of financial status every 12 months for assessment of further reimbursement eligibility.

Applicants with medication insurance cover(s) should claim for their insurance under the cover(s) first before making applications under this Programme.

 

2. Who will qualify for the Financial Assistance?

Qualified applicants must fulfill ALL the criteria below:

Clinical Requirement

  • Only for breast cancer patients who are receiving XGEVATM vials
  • The XGEVATM vials must be prescribed by:
    1. Registered Surgeons or Medical Oncologists or Clinical Oncologists under the Medical Council of Hong Kong; or
    2. Registered doctors in Department of Surgery, Department of Medicines, Department of Clinical Oncology or Oncology Center of public or private hospitals in Hong Kong; or
    3. Registered doctors in Department of Surgery, Department of Medicine or Department of Clinical Oncology of local universities in Hong Kong

Residence Requirement

A permanent resident of HKSAR

Financial Requirement

Subject to the household size of the applicant, the average monthly household income can reach up to HK$70,000. The larger the household size, the higher the household income we will accept:

Financial criteria
Household size Average monthly household income in the last 12 months Annual Disposable Financial Resources
1-3 ≤HK$50,000
4 ≤HK$60,000
5 ≤HK$65,000
6 or more ≤HK$70,000
Recipients of Comprehensive Social Security Assistance (CSSA)* Waived


Subsidization Level

Drug Name Subsidization supported by the program
XGEVATM HK$ 1,300 per 120mg vial


Note:

  1. 1. Annual Disposable Financial Resources = Annual Household Income + Household Disposable Assets - Annual Household Expenses
  2. 2. Applicants who have benefited from other XGEVA financial assistance programmes cannot apply for this programme

 

3. Documents required for first time application

Original copy of:

a.  Breast Cancer Drug Assistance Program - XGEVATM Application form
b.  Doctor’s referral letter for Breast Cancer Drug Assistance Program - XGEVATM
c. Medication receipts

Photocopy of:

d. HKSAR identity card
e. Proof of identity of family members under the same household (identity card, marriage certificate, birth certificate or other proofs of relationship)
f. Related financial proof - Financial qualification is evaluated based on total household financial situation. Applicant must provide supporting documents such as proof of income, assets and expenses of individual and other household members, if any

Documents for financial assessment

1. Proof of household income 

Employed persons Bank statement, bank account passbook, salary statement or certified documents issued by the employer
Self-employed persons Latest tax return statement or income declaration
Unemployed persons Documentary proof of unemployment (e.g. letter of termination from the employer, etc.)
Beneficiary of other drug financial assistance programme(s) Proof of successful application of such programme(s)
CSSA applicant A copy of Certificate of Comprehensive Social Security Assistance Recipients (for the purposes of financial assessment exemption)


2. Proof of household capital assets

  • Bank account passbook or statement for the past 6 months relating to all the bank accounts disclosed in the application, including but not limited to saving deposit, time deposit, foreign currency deposit, investments and securities/stocks, etc.
  • Documentary proof of shares, other investments and insurance compensation
  • Documentary proof of properties (excluding the primary residence owned)

 

3. Proof of household expenses/medical costs

  • Monthly statement of mortgage repayment and/or monthly rental statement
  • Record of monthly contribution to pension/retirement scheme/mandatory provident fund
  • Record of medical bills from public hospitals/private clinics
  • Record of child care expenses
  • Documentary proof of school fees

 

4. Application procedure

Please download and fill in the  application form or obtain in person at HKBCF office. Completed form should be returned by post with required documents to:

Hong Kong Breast Cancer Foundation
22/F, Jupiter Tower, 9 Jupiter Street, North Point, Hong Kong.
(Please mark "Application for Breast Cancer Drugs Financial Assistance Programme- XGEVA™ " on the envelope.)

Qualified applicant will be notified individually by post upon HKBCF’s validation of submitted application and relevant supporting documents. Reimbursement will be arranged by cheque made payable to the applicant by post. Please allow 6 to 8 weeks for processing.

5. Important notice

Patient:

  • Please read carefully the eligibility criteria to find out whether you are qualified to join the Programme.
  • Once the applicant is qualified, only the Application Form, doctor’s referral letter and official medication receipts are required for subsequent reimbursements.

 

Doctor:

  • Please state clearly on the doctor’s referral letter the dosage of the drug your patient is prescribed.

Remarks:

  • This Programme is for individual patients only and is not intended for clinics or hospitals.
  • HKBCF does not endorse or promote any drugs under the Breast Cancer Drug Financial Assistance Programme. Applicants should consult their doctors for questions on the drugs.
  • HKBCF may request further information and supporting documents from applicant, interview applicant and household members, make home visits, contact applicant’s doctor-in-charge, medical insurance or other similar drug financial reimbursement agents for more information.
  • All personal information collected will be treated in strictest confidence and in accordance to the Personal Data (Privacy) Ordinance.
  • HKBCF shall vet all applications; reserves the right for final decision and to decline any application without providing any reason.

 

6. Subsequent reimbursement submission

Once the applicant is qualified, he/she only needs to submit the following documents for subsequent reimbursement:

Drug profile - XGEVATM

Who is indicated for XGEVATM?

XGEVATM is a targeted therapy indicated for the prevention of skeletal-related events (SREs) in patients with bone metastases from solid tumours.3

 

What is XGEVATM?

XGEVATM is a fully human monoclonal antibody and the first and only Rank Ligand inhibitor to prevent skeletal-related events (SREs).3

 

Efficacy of XGEVATM

XGEVATM offers superior efficacy versus the standard of care zoledronic acid across several solid tumour types. The median time to first SRE with XGEVATM has been delayed by 6 months (21.4 months versus 15.4 months) with zoledronic acid.3

 

Possible side effects

Please tell your doctor immediately if you develop nay of these symptoms while being treated with XGEVATM:

  • Spasms, twitches, or cramps in your muscles, and/or numbness or tingling in your fingers, toes or around your mouth. These could be signs that you have low calcium levels in the blood.
  • Swollen, red area of the skin that feels hot and tender, and sometimes with fever and chills.

 

References:

1) Saad F, et al. J Natl Cancer Inst 2004;96:879-882
2) Lipton A, et al. Cancer 2000;88:1082-90

Consult your physician for details about the drug
XGEVA is a trademark of the Amgen Inc.

Hong Kong Breast Cancer Foundation www.hkbcf.org
Tel: 2525 6033
Fax:2525 6233
Address: 22/F Jupiter Tower, 9 Jupiter Street, North Point, Hong Kong