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  • House What is Lilly Cares
    • Available Medications
    • How to Apply
    • Lilly Cares Applications
    • Resources
      • Available Medications and Eligibility
      • Applications
      • Healthcare Provider Prescription Forms and Resources
      • Lilly Cares News and Reports
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

Covance 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. 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.

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Available Medications and Eligibility

Available medications prescription bottle
Available Medications
Check Your Eligibility person with check mark
Check Your Eligibility
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Applications


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
Print Application sheet on clipboard

Lilly Cares Application


Print Application
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Lilly Cares Oncology Application


Print Application
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Healthcare Provider Prescription Forms and Resources


General Prescription Fax Form

Oncology Dose Tracking / Administration Form

Prescription Fax Form Diabetes

Prescription Fax Form Emgality

Prescription Fax Form Forteo

Prescription Fax Form Humatrope

Prescription Fax Form Olumiant

Prescription Fax Form Taltz

Prescription Fax Form Verzenio and Retevmo

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Lilly Cares News and Reports


News

Lilly Cares News Release - 05/2020

Lilly Cares News Release - 03/2019

Reports

Lilly Cares 2019 Annual Report

Lilly Cares 2019 State Level Data

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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 08/2020 ©Lilly USA, LLC 2020. 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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