All patients are entitled to equal access to healthcare resources. The Department of Pharmacoeconomics at University of Texas MD Anderson Cancer Center (UTMDACC) administers a Patient Assistance Program (PAP) that provides assistance to indigent patients with free pharmaceuticals for their therapy. Drug cost is recovered through a drug reimbursement program offered by pharmaceutical companies. OBJECTIVE: The objective of this report is to examine trends in drug cost savings to indigent patients at UTMDACC using the PAP model. METHODS: A retrospective study using data from September 1996 to August 2000 was conducted to determine the value of the program. Patients were enrolled in this program if they qualified based on the Financial Classification Scale. Uninsured patients as well as under-insured patients were considered in this study. Data was analyzed to evaluate the trend in cost savings for the three fiscal years. RESULTS: Over $334 million was spent on drug cost over the period. There was an average increase of 22% per year in drug cost. The indigent patients accounted for 9% of the total patient population at UTMDACC. An estimated $33 million was spent on drugs for indigent patients during that period. The PAP system recovered a total of $16.8 million; $4.1m (1997), $4.3m (1998), $3.5m (1999), and $4.9m (2000). This accounts for 51% in drug cost recovery through this program. The fluctuation in cost saving was attributed to changes in the number of programs, number of patients enrolled, and product mix. CONCLUSION: The PAP system has provided free drugs to patients without financial resources and reduced the economic burden of this population on the health care institution. The program has created goodwill between the pharmaceutical companies, the healthcare institution, the patients and the community.