LILLY CARES

ELIGIBILITY:

  • You are a permanent, legal resident of the United States, Puerto Rico, or U.S. Virgin Islands 

  • You healthcare provider has prescribed a qualifying Lilly medication

  • You have no insurance or you have Medicare Part D

  • You are not enrolled in or have been denied Medicaid, full Low Income Subsidy (LIS, “Extra Help”), or Veterans (VA) Benefits (Humatrope patients with VA and Medicaid benefits may be eligible).

  • You meet the household income guidelines found below. (Residents of Hawaii/ Alaska should contact Lilly Cares directly).

  • For more information, review Lilly Care’s website

GROUP 1 MEDICATIONS AND QUALIFYING INCOMES

  • 1 PERSON HOUSEHOLD: $38,640

  • 2 PERSON HOUSEHOLD: $52,260

  • 3 PERSON HOUSEHOLD: $65,880

  • 4 PERSON HOUSEHOLD: $79,500

  • 5 PERSON HOUSEHOLD: $93,120

  • 6 PERSON HOUSEHOLD: $106,740

MEDICATIONS:

Cialis® (tadalafil) tablets • Cymbalata® (duloxetine delayed-release capsules) • Evista® (raloxifene hydrochloride) Table • Foreo® (teriparatide injection • Prozac® (fluoxetine capsules) • Strattera® (atomoxetine) capsule • Symbyaz® (olanzapine and fluoxetine) capsule • Zyprexa® (olanzapine)

GROUP 2 MEDICATIONS AND QUALIFYING INCOMES

  • 1 PERSON HOUSEHOLD: $51,520

  • 2 PERSON HOUSEHOLD: $69,680

  • 3 PERSON HOUSEHOLD: $87,840

  • 4 PERSON HOUSEHOLD: $106,000

  • 5 PERSON HOUSEHOLD: $124,160

  • 6 PERSON HOUSEHOLD: $142,320

MEDICATIONS:

Baqsimi® (glucagon) nasal powder • Basaglar® (insulin glargine injection) • Emgality® (galcanezumab-gnlm) injection • Glucagon™ (glucagon for injection • Humalog® (insulin lispro injection) • Humulin® (insulin human injection) • Lyumjev™ (insulin lispro-aabc) injection • Reyvoq® (lasmiditan) tablets C-V • Trulicity® (dulaglutide) injection

GROUP 3 MEDICATIONS AND QUALIFYING INCOMES

  • 1 PERSON HOUSEHOLD: $64,400

  • 2 PERSON HOUSEHOLD: $87,100

  • 3 PERSON HOUSEHOLD: $109,800

  • 4 PERSON HOUSEHOLD: $132,500

  • 5 PERSON HOUSEHOLD: $155,200

  • 6 PERSON HOUSEHOLD: $177,900

MEDICATIONS:

Humatrope® (somatropin) for injection • Olumiant® (baricitinib) tablets • Talz® (ixekizumab) injection  

HOW TO APPLY:

  1. Complete an application in English or Spanish.

  2. Your healthcare provider will need to fill out the prescriber section and prescription.

    1. You can also complete an online application

  3. Fax or mail the completed document

    1. Lilly Cares Patient Assistance Program
      P.O. Box 13185
      La Jolla, CA 92039

    2. Fax: 1-844-431-6650

LILLY CARES

REQUISITOS: 

  1. Usted es residente legal permanente de los Estados Unidos, Puerto Rico o las Islas Vírgenes de los EE.UU. 

  2. Su proveedor médico le ha recetado un medicamento de Lilly que cumple los requisitos.

  3. No tiene seguro o tiene Medicare Parte D

  4. No está inscrito en Medicaid o se le ha denegado Medicaid, el Subsidio por Bajos Ingresos (LIS, "Ayuda Adicional"), o los Beneficios para Veteranos (VA) (los pacientes de Humatrope con beneficios VA y Medicaid pueden ser elegibles).

  5. Cumple los requisitos de ingresos familiares que se indican a continuación. (Los residentes en Hawai/ Alaska deben ponerse en contacto directamente con Lilly Cares). 

  6. Para obtener más información, consulte el sitio web de Lilly Care

RELLENE UNA SOLICITUD EN INGLÉS O ESPAÑOL.

  1. Su medico tendrá que rellenar la sección del prescriptor y la receta. 

  2. También puede rellenar una solicitud en línea

  3. Enviar por fax o correo el documento cumplimentado

    • Lilly Cares Patient Assistance Program
      P.O. Box 13185
      La Jolla, CA 92039
      Fax: 1-844-431-6650