Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
Scroll down to see them all.
 

Cymbalta

View Coupon View Coupon

Lilly Cares Foundation Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Lilly USA, LLC.

PO Box 13185
La Jolla, CA 92039

TEL: 800-545-6962


FAX: 844-431-6650
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Lilly Cares Foundation Patient Assistance Program Application (pages 3-8)

Lilly Cares Foundation Patient Assistance Application Instructions (pages 1-2)

 

Medications

  • Cymbalta capsule; delayed release (duloxetine)
 

Eligibility Requirements   

Insurance Status *Contact program for details.
Those with Part D Eligible? Varies
Income Varies
Diagnosis/Medical Criteria Not specified
US Residency Required? Must reside permanently in the US or Puerto Rico
   

Application

Obtaining Call, download or apply online
Receiving Faxed
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 120 day supply
Sent To Varies
Delivery Time Contact Program for Details
Refill Process Contact program for details.
Limit Not specified
Re-application New application, new documentation yearly
   

Additional Information

Please visit www.LillyCares.com or call 800-545-6962 for more information.

Additional products may be available. Please contact the program for a complete product listing.

Lilly donates products to the Lilly Cares Foundation Patient Assistance Program.


Updated August 19, 2019


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

Cymbalta

View Coupon View Coupon

Rx Outreach Medications

This program provides medication at low cost. (Most brand names are provided for reference purposes only)

Provided by: Rx Outreach

PO Box 66536
St. Louis, MO 63166-6536

TEL: 888-796-1234


FAX: 800-875-6591
Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Rx Outreach Application

Rx Outreach Refills and New Prescription Form

Rx Outreach Medication List

Rx Outreach Diabetic Supplies Order Form (Prodigy)

 

Medications

  • duloxetine (Cymbalta capsule; delayed release)
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income At or below 400% of FPL
Diagnosis/Medical Criteria Not required
US Residency Required? Must reside in the US
   

Application

Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax or E-Prescribe online
Doctor's Action Give prescription to patient
Applicant's Action Complete section and 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 Rx Outreach website for the exact price and most current medication list.

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


Updated June 24, 2019