Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Cymbalta

Lilly Cares Patient Assistance Program

This program provides brand name medications at no or low cost.

Provided by: Eli Lilly & Company

Lilly Cares Program
PO Box 230999
Centreville, VA 20120

TEL: 800-545-6962


FAX: 703-310-2534
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Lilly Cares Patient Assistance Program Application

Lilly Cares Refill Authorization Form

 

Medications

  • Cymbalta capsule; delayed release (duloxetine)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? No, must be ineligible
Income At or below 300% of FPL
Diagnosis/Medical Criteria Must be under 65 years of age
US Residency Required? Puerto Rico & US Virgin Island residents are not eligible
   

Application

Obtaining Call or download
Receiving Faxed
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Doctor notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 120 day supply
Sent To Doctor's office
Delivery Time Within 4 weeks
Refill Process Refill/reorder form included with shipment
Limit Not specified
Re-application New application, new documentation yearly
   

Additional Information


Updated August 11, 2015


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

Cymbalta

Rx Outreach Medications

This program provides medication at low cost.

Provided by: Rx Outreach

PO Box 66536
St Louis, MO 63166-6536

TEL: 888-796-1234


FAX: 800-875-6591
Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Rx Outreach Application

Rx Outreach Diabetic Supplies

Rx Outreach Refills and New Prescriptions Order Form

Rx Outreach Medication List

 

Medications

  • Cymbalta capsule; delayed release (duloxetine)
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 300% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must reside in the US
   

Application

Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax or E-Prescribe online
Doctor's Action Give prescription to patient
Applicant's Action Complete section and sign
Decision Communicated Medications sent if accepted. If denied patient and doctor notified
Decision Timeframe Usually same day
   

Medication

Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit Only limited by manufacturer's guidelines
Re-application New application yearly
   

Additional Information

Some medications are available for a fee of $20 for up to a 180 day supply.
Check the Rx Outreach website for the exact price and most current medication list.
Contact Program for Spanish Application(s)/Form(s)
Updated July 15, 2015