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Lilly Cares Application Form - Fill Out and Sign Printable PDF 2025

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The Lilly Cares Foundation offers a Patient Assistance Program to help eligible patients obtain certain Eli Lilly medications at no cost. The application process requires patients to meet specific criteria, including residency, insurance status, and income limits. Patients can apply online or via mail, and must provide necessary documentation. The program covers various medications across three groups, with enrollment lasting 12 months. Healthcare providers also play a role in the application process by confirming prescriptions.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is there a patient assistance program for Trulicity?

For support, please call Lilly Cares at 1-800-545-6962.

How to get a prescription with no money?

Years of research and testing are needed to ensure that brand-name drugs are safe and effective. This testing can make the drugs expensive. The manufacturer of a brand-name drug can sell the drug for up to 20 years. After that, other drugmakers can create generic versions.

How to get Cymbalta for free?

Once youre enrolled in a Trulicity patient assistance program, well continue to serve as your advocate. Well make sure your Trulicity prescription is renewed as needed, and we can help you find assistance for any new medications your doctor may prescribe as well.

What is the closest antidepressant to Cymbalta?

For brand name meds, there are prescription assistance programs offered directly from the manufacturer. These programs will have you and your doctor fill out paperwork, but if you qualify, they will ship you the medicine directly for low or no cost. You can go to the manufacturers website to learn more.

What is the income limit for Lilly Cares?

Annual Adjusted Gross Income Limit Medication Groups1 Person Household*5 Person Household* Group 2 Medications 1 Person Household*: $62,600 5 Person Household*: $150,600 Group 3 4 Medications 1 Person Household*: $78,250 5 Person Household*: $188,2501 more row

How much does Cymbalta cost without insurance?

Alternative Medications to Cymbalta Lexapro. Lexapro (escitalopram) is an alternative to Cymbalta that might be good for people who are concerned about Cymbaltas effects when used long-term. Effexor (venlafaxine) Prozac (fluoxetine) Wellbutrin (bupropion)

Lilly Cares Application Form - Fill Out and Sign Printable PDF 2025

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