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.

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

Lilly Cares Application

Print Application

Lilly Cares Application
(Spanish Version)

Print Application

Lilly Cares Oncology Application

Print Application

Lilly Cares Oncology Application
(Spanish Version)

Print Application

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