Household Income Guidelines:

Total Number of Persons in your Household (including applicant) Annual Adjusted Gross Income Limit*
If you live in Alaska or Hawaii, please contact us for
annual adjusted gross income limits
Group 1 Medications Group 2 Medications Group 3 Medications
1 $36,420 $48,560 $60,700
2 $49,380 $65,840 $82,300
3 $62,340 $83,120 $103,900
4 $75,300 $100,400 $125,500
5 $88,260 $117,680 $147,100
6 $101,220 $134,960 $168,700
*Note: These income limits are 300% (Group 1 Medications), 400% (Group 2 Medications), and 500% (Group 3 Medications) of 2018 Federal Poverty Guidelines. Visit www.aspe.hhs.gov/poverty for information on the Federal Poverty Level.
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)
  • Cymbalta® (duloxetine delayed-release capsules)
  • Evista® (raloxifene hydrochloride)
  • Forteo® (teriparatide [rDNA origin] injection)
  • Prozac® (fluoxetine)
  • Strattera® (atomoxetine)
  • Symbyax® (olanzapine and fluoxetine)
  • Zyprexa® (olanzapine)
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
  • Glucagon (glucagon for injection [rDNA origin])
  • Humalog® (insulin lispro injection)
  • Humulin® (human insulin [rDNA origin])
  • Trulicity® (dulaglutide)
Group 3 Medications: For patients who have no insurance, or have Medicare Part D, or, in some circumstances, those whose insurance does not cover the prescribed Lilly medication and have a household annual adjusted gross income ≤500% FPL.
  • Humatrope® (somatropin) for injection
  • Taltz® (ixekizumab)
  • Olumiant® (baricitinib)