Astellas Stock Replacement Program Eligibility Requirements
In order for the healthcare provider or facility to receive no-cost stock replacement of Astellas medications through the Astellas Stock Replacement Program, the treated patient must satisfy the following criteria:
- Be unisured
- Have a verifiable shipping address in the United States
- Have been prescribed AmBisome® (amphotericin B) liposome for injection, for an FDA-approved indication
- Have a gross income of ≤2.5x the federal poverty levela
- Have had AmBisome administered in a healthcare facilityb
For patients who meet the eligibility criteria listed above, the provider should complete the Astellas Stock Replacement Program application and submit it via Astellas eService.
2016 HHSc Federal Poverty Guidelines
The Astellas Stock Replacement Program uses the federal poverty level (FPL) as the basis for assessing financial eligibility for patient assistance. The FPL establishes an income threshold for poverty based on the number of people in a household and is updated every year by the US Department of Health and Human Services. Under this program, patient income must be less than or equal to 2.5x the FPL to qualify for assistance for this Astellas product. The table below outlines the 2016 FPL for the continental United States, Alaska, and Hawaii, and the Astellas Stock Replacement Program financial criteria (2.5x the FPL).
|2016 Federal Poverty Level Guidelines1|
|Household Size||Continental United States||Alaska||Hawaii|
|FPL||2.5x the FPL||FPL||2.5x the FPL||FPL||2.5x the FPL|
|Each additional person||$4160||$10,400||$5200||$13,000||$4780||$11,950|
a Astellas Stock Replacement Program requires the healthcare provider or facility to retain proof of patient income on file in their office.
b Under the Astellas Stock Replacement Program, a healthcare facility may include a physician's office, clinic, hospital inpatient or outpatient department, long-term care facility, or infusion center. It is required under this program that the healthcare provider or an authorized employee at the treating facility certify that the facility is a) under no legal obligation under any federal, state, or local law or regulation to provide a patient with product, and b) will not be receiving a payment for a service that would otherwise fund the provision of the product to the patient (eg, a capitated or bundled payment for an inpatient hospital admission) and also certifies that the facility will waive charges for the administration of product from patients without any health insurance that satisfy all other eligibility criteria.
c US Department of Health and Human Services.
1. US Department of Health and Human Services. Annual update of the HHS poverty guidelines. Fed Regist 2016;80:3236-7.
AmBisome® is a registered trademark of Gilead Sciences, Inc.