Check Your Eligibility
You may be eligible for the Lilly Cares Program if:
- You are a permanent resident of the United States (inclusive of Puerto Rico and the U.S. Virgin Islands).
- Your healthcare provider has prescribed a medication offered through Lilly Cares.
- The following applies to you with regard to your insurance coverage:
- You are not enrolled in Medicaid, full Low Income Subsidy (LIS, “Extra Help”) or Veterans (VA) Benefits;
- You do not have an insurance plan requiring you to apply to the Lilly Cares Program as a condition of, requirement for, or prerequisite to coverage of relevant Eli Lilly and Company medications. A partial list of these types of ineligible programs, commonly known as alternative funding programs, patient advocacy programs or specialty networks, is provided below;* and
- Either 1) You have no insurance, or 2) you have Medicare Part D, or 3) with respect to infused medications given intravenously (IV), you have Medicare Part B but have no supplemental or secondary insurance (e.g., private insurance offered by former employer, Medigap, Medicare Advantage).
- You meet the household income guidelines for the Program.
See applications for additional Program guidelines.
Household Income Guidelines
- The total number of persons in the household (applicant and all family members).
- Total annual (yearly) income including incomes from all earners in your household.
- To qualify, your household annual income before taxes cannot be more than the values listed below.
Annual Adjusted Gross Income Limit
If you live in Alaska or Hawaii, please contact us for annual adjusted gross income limits.
Medication Groups
|
1 Person Household*
|
2 Person Household*
|
3 Person Household*
|
4 Person Household*
|
5 Person Household*
|
6 Person Household*
|
---|---|---|---|---|---|---|
Group 1 Medications | 1 Person Household*: $45,180 | 2 Person Household*: $61,320 | 3 Person Household*: $77,460 | 4 Person Household*: $93,600 | 5 Person Household*: $109,740 | 6 Person Household*: $125,880 |
Group 2 Medications | 1 Person Household*: $60,240 | 2 Person Household*: $81,760 | 3 Person Household*: $103,280 | 4 Person Household*: $124,800 | 5 Person Household*: $146,320 | 6 Person Household*: $167,840 |
Group 3 & 4 Medications | 1 Person Household*: $75,300 | 2 Person Household*: $102,200 | 3 Person Household*: $129,100 | 4 Person Household*: $156,000 | 5 Person Household*: $182,900 | 6 Person Household*: $209,800 |
Group 1 Medications: For patients who have no insurance or have Medicare Part D and have a household annual adjusted gross income ≤ 300% Federal Poverty Level (FPL).
- Cialis® (tadalafil) tablets
- Cymbalta® (duloxetine delayed-release capsules)
- Evista® (raloxifene hydrochloride) Tablet
- Forteo® (teriparatide injection)
- Prozac® (fluoxetine capsules)
Group 2 Medications: For patients who have no insurance or have Medicare Part D and have a household annual adjusted gross income ≤ 400% FPL.
- Basaglar® (insulin glargine injection)
- Emgality® (galcanezumab-gnlm) injection
- Humalog® (insulin lispro injection)
- Humulin® (insulin human injection)
- Lyumjev® (insulin lispro-aabc) injection
- Reyvow® (lasmiditan) tablets C-V
- Trulicity® (dulaglutide) injection
Group 3 Medications: For patients who have no insurance or have Medicare Part D (not applicable to infused medications†) or have Medicare Part B but have no supplemental or secondary insurance and have a household annual adjusted gross income of ≤ 500% FPL.
- Humatrope® (somatropin) for injection
- Olumiant® (baricitinib) tablets
- Omvoh™(mirikizumab-mrkz) infusion†
- Omvoh™(mirikizumab-mrkz) injection
- Taltz® (ixekizumab) injection
Group 4 Medications: For patients who have no insurance or have Medicare Part D (not applicable to infused medications†) or have Medicare Part B but have no supplemental or secondary insurance, or insurance has denied a claim for coverage and one appeal and have a household annual adjusted gross income of ≤ 500% FPL.
- Alimta® (pemetrexed for injection)†
- Cyramza® (ramucirumab) injection†
- Erbitux® (cetuximab) injection†
- Jaypirca® (pirtobrutinib) tablets
- Retevmo® (selpercatinib) capsules
- Verzenio® (abemaciclib) tablets
Use of Third Parties to Apply
The Lilly Cares Foundation does not charge patients a fee for help with enrollment, medication refills, or for participation in the Program. Lilly Cares is not affiliated with third parties that charge for assistance that Lilly Cares provides to you at no cost. For support, please call Lilly Cares at 1-800-545-6962.
For more information about Lilly’s privacy practice (as followed by Lilly Cares Foundation), please see the Privacy Statement.
Application Options
You can choose to fill out your application in one of three ways:
- You can complete an online application. Choosing to use the online application reduces paperwork and potential for delays.
Newly recommended application processing option!
- You can download a blank application, print it, and then fill in your information by hand.
- You can download a blank application, fill in the application on your computer, then save and print the completed application.
Lilly Cares now has a single application! A separate application for oncology medications is no longer required.
Ask to have an application mailed to you by calling 1-800-545-6962.
Complete the Application
Fill out and sign the patient sections on the application. Your healthcare provider will need to fill out the prescriber section and submit a prescription.
Submit your online application, or fax or mail the completed paper application to:
Lilly Cares Patient Assistance Program
PO Box 501847
San Diego, CA 92150
Fax: 1-844-431-6650
Next Steps
Lilly Cares will review your application and provide you and your healthcare provider with an enrollment decision. You will receive notification of the enrollment decision by mail and text message (if applicable). Your healthcare provider will receive a fax notification.
If your application is approved, your enrollment notification letter will tell you when your enrollment expires (generally in 12 months or at the end of the calendar year for those with Medicare Part D).
Medications will either be shipped to your home or to your healthcare provider’s office. Our pharmacy partner will call you to schedule delivery, if applicable.
At the end of the enrollment period, you must reapply to remain eligible in the Program.