Lilly Cares Foundation Patient Assistance Program
Based on the information you provided, you may be eligible for the Lilly Cares Foundation Patient Assistance Program (“Lilly Cares”).
If the Lilly Cares Foundation determines that you are eligible for the Lilly Cares program, your insulin will be provided for free for up to 12 months. You can also choose whether to have your medication shipped directly to your home or your healthcare provider’s office. If you have questions about the program or the application process, you can call Lilly Cares Foundation at 1-800-545-6962, Monday through Friday, from 8am to 6pm Eastern.
To apply for Lilly Cares, fill out the Lilly Cares program application. You can do this by clicking here: www.lillycares.com. You can either complete the application online or submit via fax.
To complete the application online, click here: www.lillycareseservice.com You will need the following information in order to submit your application:
- The email address of the healthcare professional who prescribes your insulin. You can call your healthcare provider’s office to get that email address before you fill out the application.
- A copy of your financial documents that prove your income, which will be uploaded in the online application. Financial documents could be paystubs, a wage statement (IRS W-2), a Social Security Benefit Statement (Form SSA-1099), or a copy of your unemployment statement.
To print and fax or mail a copy of the application, download the Lilly Cares program application at www.lillycares.com on the Resources tab. You can also request a Lilly Cares application be sent via mail by calling Lilly Cares Foundation at 1-800-545-6962.
- Fill out pages 2-4 and sign.
- Provide this application to your healthcare provider, who will fill out page 5-6.
- Collect your financial documentation (last year’s Federal Tax return, or paystubs, a wage statement (IRS W-2), a Social Security Benefit Statement (Form SSA-1099), or a copy of your unemployment statement.
- Either fax the application into Lilly Cares Foundation at 1-844-431-6650 or mail to the address on the application. (If you bring your financial documents with you to your healthcare provider’s office, they may be able to fax those documents to help make this process easier and faster.)
If you qualify for Lilly Cares:
- You and your healthcare provider will receive a letter notifying you of enrollment.
- You will be enrolled for 12 months. If you are Medicare Part D patient, you will be enrolled through the end of the calendar year.
- You will be contacted regarding medication shipment.
If you do not qualify for Lilly Cares, a notice will be sent to you and your healthcare provider.
