Program Applications

Tips for using the applications:

  • You will need Adobe Reader to open the applications. Download this free program or the latest version, which is recommended.
  • Click the button in the top right of the application to turn on the Highlight Fields Option which will highlight the fields to be filled out.
  • Use the "tab" key to easily go to the next field.

As of 12/14/2017 there are 614 applications available.

Click on the first letter of the name of the program. Then click on the application for that program. Dates next to each listing reflect the last update. Some applications may need to be opened with a different viewer depending on which browser you are using. Firefox users may get a message saying "This PDF document might not be displayed correctly." Try clicking on the "Open With Different Viewer" option. If you are still unable to interactively complete the application, use a different browser.

Send the completed application to the address on the application and not to NeedyMeds.

If you cannot find an application or are having trouble printing one, contact the program or company.

Contact NeedyMeds if you find any content errors.

For link problems or other technical problems, send an email to webmaster.

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Leadiant Outreach Services Information: Contact program
Leadiant Patient Assistance Program Application: Contact program
LexCares Enrollment Form 07/14/17
LexCares Patient Guide 07/14/17
LexCares Physicians Guide 07/14/17
Lilly Cares Patient Assistance Application Instructions (pages 1-3) 11/03/17
Lilly Cares Patient Assistance Program Application (pages 4-9) 11/15/17
Lilly Cares Prescription FAX Form (Forteo) 07/05/17
Lilly Cares Prescription FAX Form (Humatrope) 07/05/17
Lilly Cares Prescription FAX Form (Humulin R U-500) 07/05/17
Lilly Cares Prescription FAX Form (Taltz) 07/05/17
Lilly Patient Assistance Program Brochure 07/05/17
Lioresal Intrathecal Patient Assistance Program Application 07/24/17
Lonsurf Patient Enrollment Form 07/28/17
Lonsurf Patient Enrollment Form (Spanish) 04/11/17

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