: Lilly Cares Foundation is closely monitoring the coronavirus disease 2019 (COVID-19) pandemic. We do not anticipate shortages of Eli Lilly and Company medications provided for those in our patient assistance program (PAP).

If your job was affected by the COVID-19 crisis, you may qualify for the Lilly Cares PAP to receive your prescribed Lilly medication for free. Read eligibility details on this website and call us at 1-800-545-6962 with questions. If your proof-of-income document does not reflect your recent change of income, please include a brief letter with your application explaining your situation.

At this time, only submit your application using our online submission process or via fax using the fax number located on the bottom of the application form. Please do not mail your application.

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 or have been denied Medicaid, full Low Income Subsidy (LIS, “Extra Help”) or Veterans (VA) Benefits (Humatrope patients with VA and Medicaid benefits may be eligible).
Humatrope patients: Call Lilly Cares to review eligibility requirements.
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, including applicant.
Total yearly income includes incomes from all earners in your household.
To qualify, your total annual (yearly) adjusted gross income 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*: $38,280	2 Person Household*: $51,720	3 Person Household*: $65,160	4 Person Household*: $78,600	5 Person Household*: $92,040	6 Person Household*: $105,480
Group 2 Medications	1 Person Household*: $51,040	2 Person Household*: $68,960	3 Person Household*: $86,880	4 Person Household*: $104,800	5 Person Household*: $122,720	6 Person Household*: $140,640
Group 3 Medications	1 Person Household*: $63,800	2 Person Household*: $86,200	3 Person Household*: $108,600	4 Person Household*: $131,000	5 Person Household*: $153,400	6 Person Household*: $175,800

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*: $38,280

2 Person Household*: $51,720

3 Person Household*: $65,160

4 Person Household*: $78,600

5 Person Household*: $92,040

6 Person Household*: $105,480

Group 2 Medications

1 Person Household*: $51,040

2 Person Household*: $68,960

3 Person Household*: $86,880

4 Person Household*: $104,800

5 Person Household*: $122,720

6 Person Household*: $140,640

Group 3 Medications

1 Person Household*: $63,800

2 Person Household*: $86,200

3 Person Household*: $108,600

4 Person Household*: $131,000

5 Person Household*: $153,400

6 Person Household*: $175,800

*Total Number of Persons in your Household (including applicant).
Note: These income limits are 300% (Group 1 Medications), 400% (Group 2 Medications), and 500% (Group 3 Medications) of 2020 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) 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

Oncology Medications

Alimta^® (pemetrexed for injection)
Cyramza^® (ramucirumab) injection
Erbitux^® (cetuximab) injection
Portrazza^® (necitumumab) injection
Retevmo^™ (selpercatinib) capsules
Verzenio^® (abemaciclib) tablets

Choose An Application

You can choose to fill out your application in one of three ways:

You can complete an online application.
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.

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 prescription.

Include proof of income documentation (such as federal tax return, wage statement, or social security benefit statement).

Submit your online application, or fax or mail the completed paper application and required documents to:

Lilly Cares Patient Assistance Program
P.O. Box 13185
La Jolla, CA 92039
Fax: 1-844-431-6650

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.

Next Steps

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). Missing documents or 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.

Frequently Asked Questions (FAQ)

Eligibility Questions

To determine program eligibility, document your current financial information on the application, provide required income documentation and supporting documentation of change.

When looking at your insurance card, words like “Medicare”, “Medicare Advantage”, “Medicare Replacement”, or “Medicare Rx” would indicate Medicare insurance.

Patients with healthcare cost sharing plans are eligible for assistance as these are not health insurance plans, but are voluntary sharing among members for eligible health expenses.

Next Steps Questions

Yes. To remain in the program, you must reapply at the end of your enrollment period. You can reapply up to 60 days before your current enrollment end date. When applying for re-enrollment, please use the newest version of the application (available online).

Applications are processed in the order they are received. If the application is complete and contains all required documentation, it will be processed in about three to five business days. If the application is missing information, this can delay the processing time.

If your healthcare provider has changed, your new healthcare provider will need to submit the "Healthcare Provider" section of the application, including the signed consent, for each of the medications you receive through Lilly Cares.

Please call Lilly Cares Patient Assistance Program at 1-800-545-6962.

Patients enrolled in Lilly Cares receive a 120-day supply of medication in each shipment unless a greater/lesser amount is requested by their healthcare provider or provided per program guidelines.

No. Medications from the Lilly Cares Foundation Patient Assistance Program are shipped directly to patients or healthcare providers by contracted pharmacies.

If medication is being delivered to your home, a Lilly Cares Pharmacy agent will call to schedule your first shipment. If it's being delivered to your healthcare provider, please coordinate with your healthcare provider's office on pickup instructions. If you've opted-in to text messages, the Lilly Cares Pharmacy will send a text message letting you know your medication has shipped.

The Lilly Cares Pharmacy will call you to schedule medication shipment. If your medication is not temperature controlled, it will be delivered by ground within three to five business days once shipment is scheduled for delivery. If your medication is temperature controlled, it will be delivered by Next Day Air once the shipment is scheduled for delivery.

No. Lilly Cares provides free Lilly medications, including shipping, for patients who meet program eligibility requirements.

If you are receiving a temperature controlled medication, then an adult signature will be required.

Medication refills can be provided approximately 30 days before you have used your current medication supply.

The patient is responsible for ensuring medication refills, though Lilly Cares has tools in place to make it easier. Patients have the option of signing up for our auto-refill program, which will automatically fill most medications when due for a refill. If you've opted-in to text messages, a text message will be sent when your medication has shipped. When there are zero refills remaining, your healthcare provider will be contacted for a prescription renewal before your next refill due date. Auto-refills will stop at the end of your program enrollment period. If you no longer need the medication, contact Lilly Cares at 1-800-545-6962.

Lilly Cares offers automatic refills for most medications. Patients have the option of signing up for our auto-refill program, which will automatically fill medication when it's due for a refill. When there are zero refills remaining, the healthcare provider will be contacted for a prescription renewal before the next refill due date. Auto-refills will stop at the end of the patient's program enrollment period. If the medication is no longer needed, contact Lilly Cares at 1-800-545-6962.

Uninsured patients will receive medication through the duration of their enrollment period. Medicare Part D patients enrollment period expires at the end of the calendar year. These patients will receive a year-end refill with a quantity sufficient to complete the remainder of their enrollment. Because of this, the year-end refill quantity may be less than the usual amount received.

If your medication doesn't come with a needle, you will need to get the needles at your local pharmacy.

Your healthcare provider will need to submit a new prescription noting the prescription change to the Lilly Cares Patient Assistance Program.
Fax: 1-844-431-6650

If it's been longer than 14 business days since your application was approved and you haven't received your medication or have questions about your prescription:

Please call RxCrossroads Pharmacy at 1-855-735-4486 for Alimta, Baqsimi, Basaglar, Cialis, Cymbalta, Cyramza, Emgality, Erbitux, Evista, Glucagon, Humalog, Humulin, Lyumjev, Portrazza, Prozac, or Strattera.

Please call Covance Specialty Pharmacy at 1-866-842-2147 for Forteo, Humatrope, Olumiant, Retevmo, Reyvow, Taltz, or Verzenio.