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

Strattera

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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:

English

Program Website

 

Program Applications and Forms

Lilly Cares Patient Assistance Program Application

Lilly Cares Refill Authorization Form

 

Medications

  • 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
   

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