Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
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Updated April 06, 2015
 

Humalog

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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


ALT PHONE:
FAX: 703-310-2534
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Lilly Cares Patient Assistance Program Application

Lilly Cares Refill Authorization Form

 

Medications

  • Humalog Injection 10mL/vial, 3mL/vial (insulin lispro injection (rDNA origin))
  • Humalog Injection; Prefilled Pen 3mL (insulin lispro injection (rDNA origin))
  • Humalog Injection; Cartridge 3mL (insulin lispro injection (rDNA origin))
  • ()
 

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



Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2. Updated April 08, 2015
 

Humalog

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LillyMedicareAnswers Program

This program only helps people enrolled in Medicare Part D.

Provided by: Eli Lilly & Company

PO Box 66977
St. Louis, Missouri 63166-6747

TEL: 877-795-4559


ALT PHONE:
FAX: 800-692-0331
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

LillyMedicareAnswers Patient Assistance Program Application

 

Medications

  • Humalog Injection dosage varies (insulin lispro injection rDNA origin)
 

Eligibility Requirements   

Insurance Status Must be enrolled in a Medicare Part D prescription plan
Those with Part D Eligible? Yes, but have been denied or are ineligible for Low Income Subsidy
Income At or below 300% of FPL
Diagnosis/Medical Criteria Not disclosed
US Residency Required? United States or Puerto Rico
   

Application

Obtaining Call or download
Receiving Faxed or mailed
Returning Fax or mail
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign, attach copy of Medicare Part D card, proof of income and low-income subsidy denial
Decision Communicated Patient notified
Decision Timeframe Within 2 weeks
   

Medication

Amount/Supply Up to 90 day supply
Sent To Patient's home
Delivery Time Not specified
Refill Process Patient must contact company
Limit Not specified
Re-application Must re-enroll at end of calendar year
   

Additional Information

For the medication Forteo, this is one-time program and maximum enrollment is for 2 years. Patient must reapply every year.

You must have been denied low-income subsidy and are not enrolled in Medicaid.