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


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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

FAX: 703-310-2534
Languages Spoken:


Program Website


Program Applications and Forms

Lilly Cares Patient Assistance Program Application

Lilly Cares Refill Authorization Form



  • Strattera capsule (atomoxetine)

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


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


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

Medication ERBITUX will not be available until 10/01/2015. Contact program for details.

Updated November 05, 2015