The Hospital Access Patient Assistance Program Prescription Assistance Program

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The Hospital Access Patient Assistance Program is an outpatient, pharmacy‑based program designed to assist patients who lack access to prescription medication coverage through either public or private sources. Patients must meet established financial criteria and receive treatment at a Disproportionate Share Hospital (DSH)* or Diagnosis-Related Group-exempt (DRG-exempt) Cancer Center**. The hospital enrolls patients using the program’s eligibility requirements. Patients receive their prescription medications at no charge from the hospital's outpatient pharmacy.

A Disproportionate Share Hospital is a hospital with a disproportionately large share of low-income patients. Under Medicaid, states augment payment to these hospitals. Medicare inpatient hospital payments are also adjusted for this added burden.
Source: Centers for Medicare and Medicaid Services.

When Congress crafted a system in 1983 to control hospital costs charged to Medicare, it gave a special break to cancer hospitals, whose costs are usually higher than average. As a result, specific cancer centers were exempt from the Prospective Payment System, receiving cost-based reimbursement instead. Source: Vanchieri, Cori (1991). Handful of Cancer Centers Exempt from Prospective Payment System. Journal of the National Cancer Institute, 83 (13), 907-908.

Which patients qualify for the Hospital Access Patient Assistance Program?
Enrolled DSH facilities or DRG-exempt Cancer Centers determine their patients’ eligibility using the same eligibility requirements as the Patient Assistance Programs. A patient:

Must not have private or public health insurance, such as Medicaid or Medicare.
Must meet specific financial criteria.
Must live in the United States or a United States Territory.
Must be an outpatient under the care of a valid licensed United States health care prescriber (such as a physician, nurse practitioner or clinical nurse specialist).

Which prescription medications are covered by the Hospital Access Patient Assistance Program?
The following prescription medications are included in this program:

INVEGA™ (paliperidone) Extended-Release Tablets
RISPERDAL^® (risperidone) Tablets/Oral Solution
LEVAQUIN^® (levofloxacin) Tablets/Oral Solution
ULTRACET^® (tramadol hydrochloride/acetaminophen) Tablets
TOPAMAX^® (topiramate) Sprinkle Capsules and Tablets
DITROPAN XL^® (oxybutynin chloride) Extended-Release Tablets

What are the program parameters?
The program is intended to provide qualified patients access to medications through a qualified DSH or DRG-exempt Cancer Center. DSH facilities and DRG-exempt Cancer Centers are assessed for eligibility according to standardized criteria. Following approval, the DSH facility or DRG-exempt Cancer Center is required to sign a contract, follow standardized patient eligibility guidelines and agree to regular on-site audits.

Speak to an access2wellness specialist. Call 866-317-2775.


Call 800-652-6227 to have a Hospital Access Patient Assistance Program specialist answer your questions, help you assess your hospital’s eligibility and, if appropriate, send you an application for the Hospital Access Patient Assistance Program.


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