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Program 1 of 2.
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Updated February 07, 2014
Prozac

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

  • Prozac Capsule; Pulvule 10mg, 20mg, 40mg (fluoxetine HCl)
 

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 Not specified
US Residency Required? Puerto Rico & US Virgin Island residents are not eligible
   

Application

Obtaining Call or download
Receiving Faxed
Returning Mail or fax
Doctor's Action Complete section, 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 March 04, 2014
Prozac

Rx Outreach Medications

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

Provided by: Rx Outreach

PO Box 66536
St Louis, MO 63166-6536

TEL: 888-796-1234


ALT PHONE: 888-RXO-1234
FAX: 800-875-6591
Languages Spoken:

English, Spanish

Program Website
 

Patient Assistance Applications

Rx Outreach Application

Rx Outreach Diabetic Supplies

Rx Outreach Medication List

Rx Outreach Refills and New Prescriptions Order Form

 

Medications

  • Prozac Tablet 10mg, 20mg, 40mg (fluoxetine)
 

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 or mailed
Returning Fax or E-Prescribe online
Doctor's Action Give prescription to patient
Applicant's Action Complete section, 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 website for the exact price.

Contact Program for Spanish Application(s)/Form(s)