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 (as followed by Lilly Cares Foundation), please see the Privacy Statement.
Choose An Application
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.
- 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.