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

Trulicity

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Lilly Cares Foundation Patient Assistance Program

This program provides medication at no cost.

Provided by: Lilly USA, LLC.

PO Box 13185
La Jolla, CA 92039

TEL: 800-545-6962


FAX: 844-431-6650
Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Lilly Cares Foundation Patient Assistance Program Application

 

Medications

  • Trulicity injection (dulaglutide)
 

Eligibility Requirements   

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

Application

Obtaining Call, download or apply online
Receiving Faxed
Returning Fax, mail or submit online
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 Doctor's office or patient's home
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 April 08, 2021