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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Eli Lilly & Company |
| Program Name |
Lilly Cares Foundation Patient Assistance Program |
| Program Address |
Lilly Cares Program
PO Box 230999
Centerville, VA 20120
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| Phone Number |
800-545-6962
800-488-2133
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| Fax Number |
703-310-2534 |
| Medications on Program |
Cialis Tablet 2.5mg, 5mg, 10mg, 20mg (tadalafil)
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| Application Forms |
Lilly Cares Patient Assistance Program
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On-line Application
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No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient can have no public or private prescription insurance and have an income at or below 300% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. Patients who are eligible for any government program, including Part D, are not eligible for this program.
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| Application Process |
Anyone requesting assistance can call to request a faxed application or download it from the website. The application will be faxed out. The completed application can be faxed or mailed back.
Allow 4 weeks for processing and delivery of medication.
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| Application Requirements |
The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income.
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| Program Details |
Up to a 120-day supply is sent to the doctor's office. A refill/reorder form is included with each shipment that must be filled out and returned to get the next shipment. Once a year a new application with financial documentation is needed.
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| Last Updated |
October 02, 2009 |
