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  • House What is Lilly Cares
    • Available Medications
    • How to Apply
    • Lilly Cares Applications
    • Resources
Phone:
1-800-545-6962
Monday–Friday
8 a.m. to 6 p.m. ET

Fax:
1-844-431-6650

Address:
PO Box 13185
La Jolla, CA 92039

For questions regarding your prescriptions or medication shipment, please contact the appropriate Lilly Cares Pharmacy Partner

RxCrossroads Pharmacy Phone:
1-855-735-4486

Labcorp Specialty Pharmacy Phone:
1-866-842-2147
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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. Please include a brief letter with your application explaining your change in income.

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.

Annual re-enrollment for Medicare Part D patients is now open. To continue receiving medication through Lilly Cares, Medicare Part D patients must reapply and meet program eligibility requirements. Re-enrollment applications are being mailed to patients and Healthcare Providers. For questions about the Medicare Part D re-enrollment process, please contact Lilly Cares at 1-800-545-6962 .


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Choose An Application


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

  1. You can complete an online application.
  2. You can download a blank application, print it, and then fill in your information by hand.
  3. You can download a blank application, fill in the application on your computer, then save and print the completed application.
Online Application sheet on red computer

Online Applications


Start Online Application
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Lilly Cares Application


Print Application
Print Application sheet on clipboard

Lilly Cares Application (Spanish Version)


Print Application
Print application sheet on clipboard with molecule

Lilly Cares Oncology Application

Print Application

Ask to have an application mailed to you by calling 1-800-545-6962.

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You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
You may also report negative side effects to The Lilly Answers Center (TLAC) at 1-800-LillyRx (1-800-545-5979).


This site is intended for U.S. residents age 18 and over only. Models used for illustrative purposes only. Not actual patients or healthcare providers.
PP-AP-US-0428 10/2021 ©Lilly USA, LLC 2021. All rights reserved.
All Lilly product names mentioned herein are either trademarks or registered trademarks owned or licensed by Eli Lilly and Company, its subsidiaries, or affiliates.

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