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. |
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Lilly Cares Foundation Patient Assistance ProgramThis program provides medication at no cost. @if> |
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Provided by: Lilly USA, LLC. |
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PO Box 13185 TEL: 800-545-6962FAX: 844-431-6650 |
Languages Spoken:
English, Spanish |
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Program Applications and Forms |
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Lilly Cares Foundation Patient Assistance Program Application
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Lilly Cares Foundation Patient Assistance Program Application (Spanish)
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Medications |
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Eligibility Requirements |
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Insurance Status | Contact program for details. | ||
Those with Part D Eligible? | Yes, but contact program for details | ||
Income | Varies | ||
Diagnosis/Medical Criteria | Not specified | ||
US Residency Required? | Must reside in the US, Puerto Rico or the USVI | ||
Application |
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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 |
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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 |
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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. |
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Updated August 02, 2022 |
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Program 2 of 2. | |||
Rx Outreach MedicationsThis program provides medication at low cost. (Most brand names are provided for reference purposes only) @if> |
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Provided by: Rx Outreach |
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PO Box 66536 TEL: 888-796-1234FAX: 800-875-6591 |
Languages Spoken:
English, Spanish |
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Program Applications and Forms |
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Rx Outreach Application |
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Rx Outreach Application (Spanish) |
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Rx Outreach Refills Form |
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Rx Outreach Medication List (Alphabetized) |
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Rx Outreach Medication List (by Disease State) |
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Rx Outreach Medication List (by Disease State) (Spanish) |
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Rx Outreach Diabetic Supplies Order Form (Prodigy) |
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Medications |
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Eligibility Requirements |
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Insurance Status | May have insurance | ||
Those with Part D Eligible? | Yes, but contact program for details | ||
Income | Determined case by case | ||
Diagnosis/Medical Criteria | Not required | ||
US Residency Required? | Must reside in the US | ||
Application |
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Obtaining | Call, download or apply online | ||
Receiving | Faxed, mailed or downloaded from website | ||
Returning | Fax | ||
Doctor's Action | Give prescription to patient | ||
Applicant's Action | Complete section and sign | ||
Decision Communicated | Patient and/or Doctor are notified | ||
Decision Timeframe | Usually same day | ||
Medication |
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Amount/Supply | Varies | ||
Sent To | Doctor's office or patient's home | ||
Delivery Time | Not specified | ||
Refill Process | Company contacts patient to arrange | ||
Limit | Varies per medication | ||
Re-application | New application yearly | ||
Additional Information |
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Rx Outreach has expanded the eligibility guidelines beyond 400% FPL to include people affected by COVID-19. 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). |
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Updated June 30, 2022 |