Patient Assistance Program Applications L
Tips for using the applications:
As of 05/25/2013 are 372 applications available.- To open the applications, you need a free program called Adobe Reader. Click HERE to download this program or the latest version, which we recommend.
- Click the button in the top right of the application to turn on the Highlight Fields Option which will highlight the fields to be filled out.
- Use the "tab" key to easily go to the next field.
Click on the first letter of the name of the program. Then click on the application for that program. Send the completed application to the address on the application and not to NeedyMeds.
If you cannot find an application or are having trouble printing one, contact the program or company.
Contact us if you find any errors or have a better copy of an application. For link problems or other techincal problems, send an email to Rich Sagall.
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Leo Pharma Patient Assistance Program 08/06/12
Letairis Patient Application (English) 05/17/13
Letairis Patient Application (Spanish) 05/17/13
Letairis Physician Form 05/17/13
Lilly Cares Patient Assistance Program 01/16/13
Lilly Cares Refill Authorization Form 01/16/13
LillyMedicareAnswers Program 01/24/13