| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | ||||||
View Coupon |
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Lilly Cares Patient Assistance ProgramThis program provides brand name medications at no or low cost |
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Provided by: Eli Lilly & Company |
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TEL: Closed Program |
Languages Spoken:
English
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Patient Assistance Applications |
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Generic Name Medications |
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Eligibility Requirements |
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| Insurance Status | Must have no prescription coverage | |||||
| Those with Part D Eligible? | Determined case by case | |||||
| Income | Varies | |||||
| Diagnosis/Medical Criteria | Must be under 65 years of age | |||||
| US Residency Required? | Puerto Rico & US Virgin Island residents are not eligible | |||||
Application |
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| Obtaining | Call or download | |||||
| Receiving | Faxed | |||||
| Returning | Fax or mail | |||||
| Doctor's Action | Complete section and sign | |||||
| Applicant's Action | Complete section, sign, attach required documents | |||||
| Decision Communicated | Patient notified of denial in writing | |||||
| Decision Timeframe | ||||||
Medication |
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| Amount/Supply | ||||||
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| Refill Process | ||||||
| Limit | ||||||
| Re-application | New application, new documentation yearly | |||||
Additional Information |
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| Closed Program Updated Company Name. See: The Lilly Cares Foundation, Inc. |
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| Updated April 28, 2017 | ||||||
