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*The Lilly Cares Foundation offers the Lilly Cares Patient Assistance Program as a charitable program for patients in financial need based on income and other eligibility criteria. It may not be used by those with private commercial insurance, including alternative funding programs.
For Novo Nordisk product inquiries: 1-800-727-6500. For information about our diabetes Patient Assistance Program: 1-866-310-7549 Monday-Friday, 8 AM - 8 PM ET.
A Patient Assistance Program (PAP): Offers free diabetes medication to people in need who meet certain eligibility criteria. To learn more about our patient assistance programs and how to apply, click here or call 866-310-7549.
For support, please call Lilly Cares at 1-800-545-6962.
Complete all the following sections ing to the instructions: Patient information, eligibility, signatures, and date. Gather proof of income. Examples include a Federal tax return (1040), social security benefit forms (SSA1099), pension interest, retirement benefits, child support, or other sources.
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People also ask

Eligibility and enrollment Patients must be a US citizen or legal resident, must have a total household income at or below 400% of the federal poverty level, and must be uninsured or have Medicare. If approved, how long am I enrolled in the program? Uninsured patients are enrolled for 12 months.
Those who may qualify must be at least 18 years of age or older, a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam, or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less.
Reorders can be requested by completing and submitting the Refill Request Form below or by calling Novo Nordisk toll-free at 1-866-310-7549. Patients can renew each year for as long as they qualify. For uninsured patients, an approved application is valid for 12 months.

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