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Helping to promote excellence in patient care
Lilly Cares Foundation Patient Assistance Program application
Lilly Cares Foundation Patient Assistance Program brochure:
If you know someone who may benefit from the Lilly Cares Foundation Patient Assistance Program, this brochure provides our toll-free number and website information.
Prescription Fax Form templates or refills for a Lilly Cares product:
The healthcare provider may use these optional Prescription Fax form templates when prescribing Forteo®, Humatrope®, Taltz®, or when ordering refills for a Lilly Cares product.

Forteo Prescription Fax Form when ordering Forteo.
Humatrope Prescription Fax Form when ordering Humatrope.
Taltz Prescription Fax Form when ordering Taltz.
Lilly Cares Fax Refill Order Form when ordering refills (excluding Forteo, Humatrope, Taltz) for enrolled Lilly Cares Patients.