Check Your Eligibility
You may be eligible for the Lilly Cares program if:
- You are a permanent, legal resident of the United States, Puerto Rico, or U.S. Virgin Islands.
- Your healthcare provider has prescribed a qualifying Lilly medication.
- You have no insurance or you have Medicare Part D.
- You are not enrolled in Medicaid, full Low Income Subsidy (LIS, “Extra Help”) or Veterans (VA) Benefits.
- 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.
1 Person Household*
2 Person Household*
3 Person Household*
4 Person Household*
5 Person Household*
6 Person Household*
|Group 1 Medications||1 Person Household*: $40,770||2 Person Household*: $54,930||3 Person Household*: $69,090||4 Person Household*: $83,250||5 Person Household*: $97,410||6 Person Household*: $111,570|
|Group 2 Medications||1 Person Household*: $54,360||2 Person Household*: $73,240||3 Person Household*: $92,120||4 Person Household*: $111,000||5 Person Household*: $129,880||6 Person Household*: $148,760|
|Group 3 Medications||1 Person Household*: $67,950||2 Person Household*: $91,550||3 Person Household*: $115,150||4 Person Household*: $138,750||5 Person Household*: $162,350||6 Person Household*: $185,950|
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)
- Strattera® (atomoxetine) capsules
- Symbyax® (olanzapine and fluoxetine) capsules
- 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.
- Baqsimi® (glucagon) nasal powder
- Basaglar® (insulin glargine injection)
- Emgality® (galcanezumab-gnlm) injection
- Glucagon™ (glucagon for 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 and have a household annual adjusted gross income ≤500% FPL.
- Humatrope® (somatropin) for injection
- Olumiant® (baricitinib) tablets
- Taltz® (ixekizumab) injection
- Alimta® (pemetrexed for injection)
- Cyramza® (ramucirumab) injection
- Erbitux® (cetuximab) injection
- Portrazza® (necitumumab) injection
- Retevmo® (selpercatinib) capsules
- Verzenio® (abemaciclib) tablets
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.
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 prescription.
Submit your online application, or fax or mail the completed paper application to:
Lilly Cares Patient Assistance Program
P.O. Box 13185
La Jolla, CA 92039
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, please see the Privacy Statement.
Lilly Cares will review your application and provide you and your healthcare provider with an enrollment decision by mail (and text message, if you choose the text option on the application). An incomplete application will delay an enrollment decision.
If you meet the eligibility requirements, you will be enrolled for 12 months. Medicare Part D patients will be enrolled through the end of the calendar year.
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.