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

PatientOne Oncology

This program provides brand name medications at no or low cost

Provided by: The Lilly Cares Foundation, Inc.

PO Box 12207
La Jolla, CA 92039

TEL: 866-472-8663


FAX: 877-366-0585
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

PatientOne Assistance Application

 

Brand Name Medications Covered

 
  • Alimta injection
  • Lartruvo
  • Cyramza injection
  • Portrazza
  • Erbitux
  • Verzenio
  • Gemzar injection
 

Generic Name

 
  • abemaciclib
  • olaratumab
  • cetuximab
  • pemetrexed injection
  • gemcitabine injection
  • ramucirumab injection
  • necitumumab
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Not specified
Income At or below 500% of FPL
Diagnosis/Medical Criteria Must be used for on-label diagnosis
US Residency Required? Yes
   

Application

Obtaining Call or download
Receiving Faxed
Returning Fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Health care provider notified via fax
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Doctor's office
Delivery Time Not specified
Refill Process Doctor/Doctor's office must complete replacement form
Limit Not specified
Re-application New enrollment every 12 months
   

Additional Information

The patient and physician must submit information to PatientOne for a benefits investigation before application will be given for the assistance program. For underinsured patients program helps connect patients with programs that can help them cover the cost of copayments and deductibles. Patients who do not have prescription insurance are reviewed for eligibility into the PatientOne patient Lilly assistance program.

Certification of Brand Name Drug Usage Form only needs to be completed for those seeking assistance for Gemzar.


Updated November 14, 2017