How to Apply for Lilly cares application online, Print Application & PDF

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What is the Lilly Cares Foundation

Lilly cares foundation patient assistance program- Lilly Cares Foundation, Inc. (Lilly Cares) is a non-profit charitable organization dedicated to the Lilly works to provide prescribed Lilly medicines free of cost to eligible patients for up to 12 months. Over the past 20 years, Lilly Cares has helped more than one million patients in financial need obtain medicines donated by Lilly.

Its main objective is to help patients in financial need get their prescribed Eli Lilly & Co (Lilly) medicines at no cost.

What is the eligibility?

  • You are in the United States, Puerto Rico or the U.S. Must be a permanent, legal resident of the Virgin Islands.
  • Your healthcare provider has prescribed a qualified Lily medicine.
  • You have no insurance or have Medicare Part D.
  • You are not enrolled in Medicaid, Full Low-Income Subsidy (LIS, “Additional Assistance”) or Veterans (VA) benefits.
  • You must meet household income guidelines for the program.

Household income guidelines

The total number of persons in the household (applicant and all family members).

Total annual (annual) income which includes income from all the earners in your household.

To qualify, your household annual income before taxes cannot exceed the values listed below.

Medication Groups1 Person Household*2 Person Household*3 Person Household*4 Person Household*5 Person Household*6 Person Household*
Group 1 Medications$40,770$54,930$69,090$83,250$97,410$111,570
Group 2 Medications$54,360$73,240$92,120$111,000$129,880$148,760
Group 3 Medications$67,950$91,550$115,150$138,750$162,350$185,950

Lilly cares application process

You can complete your application in one of three ways.

  1. You can complete an online application. Choosing to use an online application helps in reducing the chances of paperwork and delays.
  2. You can download a blank application, take a printout of it and then fill in your details manually.
  3. You can download a blank application, and fill out the application on your computer, then save and print the completed application.

How to Apply for Lilly cares application online?

To apply for the Lilly cares application online, you must check the eligibility criteria and then follow the step below.

Step 1: First of all, Visit the official website – https://www.lillycares.com/lilly-cares-application

Step 2: Click on the “Start Application Online”.

Step 3: You will get the pop window, read and please click on the “Continue ” button.

Step 4: Now you can easily scroll down and choose according to your needs in “I am a Patient” or “I am a Healthcare Provider“.

Step 5: If you select “I am a Patient” then you will have to fill in all the required information. like –

  1. Patient Information
  2. Medication Information
  3. Patient Income Information
  4. Healthcare Provider Information
  5. Insurance Information

Step 6: After that upload it in Attach Any Required Document(s) option. And continue with the form.

Step 7: After that, you have to complete the further process. The form has to be submitted.

How to download the Lilly cares application pdf?

To download the Lilly cares application pdf form, you must click on the given download link. and fill out the form with all required details and complete the form.

How to contact you?

To contact for any query you can fax on this address or phone.

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

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