Apply to Lilly Cares

Lilly's foundation gives certain Lilly medicines free to people with limited income who are uninsured or on Medicare. Your answers stay in this browser; we never see them.

Who can apply?

Yearly household income before taxes, 2026 limits
Medicines1 person2 people3 people4 people
Cialis, Emgality, Forteo, Reyvow, Trulicity$47,880$64,920$81,960$99,000
Basaglar, Humalog, Humulin, Lyumjev$63,840$86,560$109,280$132,000
Ebglyss, Omvoh, Olumiant, Taltz, Cyramza
and 6 moreErbitux, Inluriyo, Jaypirca, Kisunla, Retevmo, Verzenio
$79,800$108,200$136,600$165,000

300% of the poverty level for group 1 medicines, 400% for insulins, 500% for groups 3 and 4. Alaska, Hawaii and households over four: call for the limit.

Medicare Part D, or Part B without a supplement, qualifies (Part D doesn't apply to infused medicines). Private insurance only for group 4 medicines the plan doesn't cover, with the denial attached. Not with Medicaid, full Extra Help or VA benefits.

Not for people whose employer or plan sends them to the program as a condition of coverage.

Your answers

Check each one. Signatures, dates and consent boxes stay blank for you to do by hand.

Medicine
Name and strength, e.g. Trulicity 1.5 mg. Goes on the note for your prescriber; they write the prescription.
You
Two letters, e.g. FL
10 digits
Household
Wages, Social Security, pensions, disability and any other income. 0 if none.
Coverage
Which health coverage do you have?
Has your employer or plan told you to apply to this program as a condition of your drug coverage?Your doctor's office, pharmacy or family suggesting it doesn't count. With no insurance at all, the answer is No: don't ask.
Delivery
Where should the medicine go? (optional)
Refill automatically when a refill is due? (optional)
Helpers
Optional: a family member or caregiver.

Then what?

  1. Sign

    • Patient Certification Agreement (page 6)
    • HIPAA authorization (page 7)

  2. Attach

    • For group 4 or infused medicines with insurance: the insurance denial

  3. Your prescriber

    • Completes and signs the prescriber section and prescription (pages 8 and 9), or sends an electronic prescription to Neovance Specialty Pharmacy
    • Can fax the whole application to Lilly Cares

  4. Send

    • Fax 1-844-431-6650
    • Mail to Lilly Cares Foundation Patient Assistance Program, PO Box 501847, San Diego, CA 92150

Rather apply online? Apply on the Lilly Cares site.

Questions: call Lilly Cares at 1-800-545-6962. Usually 12 months, or the end of the calendar year with Medicare Part D; then reapply.

Free. Lilly Cares does not charge patients a fee for help with enrollment. EveryCard Rx isn't paid by the program and never sends anything for you. Form CMAT-02998 12/2025, rules checked 2026-11-06 from the program's own pages. Something out of date? Tell us.