Household Income Guidelines:

Number of Persons in your Household Annual Adjusted Gross Income Limit*
If you live in Alaska or Hawaii, please contact us for
annual adjusted gross income limits
Group A Products Group B Products
1 $36,420 $60,700
2 $49,380 $82,300
3 $62,340 $103,900
4 $75,300 $125,500
5 $88,260 $147,100
6 $101,220 $168,700
For each additional person add: $12,960 $21,600
*Note: These income limits are 300% (Group A Products) and 500% (Group B Products) of 2018 Federal Poverty Guidelines. Visit www.aspe.hhs.gov/poverty for information on the Federal Poverty Level. Federal Poverty guidelines may change yearly and are updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2).
Group A Products: For patients who are eligible for and have enrolled in Medicare Part D OR have no insurance.
  • Basaglar® (insulin glargine injection)
  • Cialis® (tadalafil)
  • Cymbalta® (duloxetine delayed-release capsules)
  • Evista® (raloxifene hydrochloride)
  • Forteo® (teriparatide [rDNA origin] injection)
  • Glucagon (glucagon for injection [rDNA origin])
  • Humalog® (insulin lispro injection)
  • Humulin® (human insulin [rDNA origin])
  • Prozac® (fluoxetine)
  • Strattera® (atomoxetine)
  • Symbyax® (olanzapine and fluoxetine)
  • Trulicity® (dulaglutide)
  • Zyprexa® (olanzapine) tablets / Zyprexa® Relprevvâ„¢
    (olanzapine for extended release injectable suspension) /
    Zyprexa® Zydis® (olanzapine) tablets, orally disintegrating
Group B Products: For patients who are eligible for and have enrolled in Medicare Part D OR have no insurance OR in some circumstances those whose insurance does not cover the Lilly medication.
  • Humatrope® (somatropin) for injection
  • Olumiant® (baricitinib)
  • Taltz® (ixekizumab)