Lilly Cares® Foundation Patient Assistance Program
Welcome to the Lilly Cares Foundation Patient Assistance Program Application eService website. The Lilly Cares Foundation, Inc. ("Lilly Cares") is a nonprofit organization that offers a patient assistance program (“Program”) to help qualifying patients obtain certain Eli Lilly and Company (“Lilly”) medications at no cost.
Steps to apply online to Lilly Cares
Our online application process will guide you through the steps needed to complete and submit your portion of the online application:
- Step One: Enter your information into the online application.
- Step Two: Upload (attach electronic copies of) your supporting documents.
- Step Three: Submit your application information.
- Step Four: Electronically sign (eSignature, eSign, E-SIGN) and date the certifications (agreements) and consents to begin processing and review of your application. eSignature is required for online applications, please proceed only if you are willing to eSign the application upon completion.
- Step Five: You will receive notification of enrollment by letter and text message (if applicable) and healthcare provider will receive by fax.
Information about Applying Online
- To apply to Lilly Cares online, a patient applicant and their healthcare provider (HCP) will submit application information separately. To complete the online application, you can type your information directly in this website and then upload (attach electronic copies of) required documents. Once a patient or healthcare provider submits their portion of an application, Lilly Cares will then provide a link through an email to the other party (patient or healthcare provider) to obtain their needed information to complete the application.
- To submit a Lilly Cares application online, the person starting the application process must provide an accurate email address for both the patient and the HCP who will be completing the application. If the person starting the application process does not know the correct email addresses for both individuals, a paper version of the Lilly Cares application may be submitted and is available for printing from the Resources tab of www.lillycares.com or by calling Lilly Cares at 1-800-545-6962.
- The online application process will take about 15-20 minutes. As you work through the online application process you will not be able to save information to complete the application process at a later time. Please note, to protect your personal information, the submission process will time out after 30 minutes of inactivity, and you will lose all entered information.
- The Lilly Cares Foundation offers the Lilly Cares Patient Assistance Program as a charitable program for financially needy patients based on income and other eligibility criteria. It may not be used by those with private commercial insurance, including “alternative funding programs.” Patients with private insurance, regardless of whether their plan covers a Lilly product, may not be eligible for the Lilly Cares Program. If an employer, plan, or other third-party directs patients to apply to the Lilly Cares Program as a condition of, requirement for, or prerequisite to coverage, or in any way adjusts coverage based on application to or availability of the Lilly Cares Program, those beneficiaries are not eligible for the Lilly Cares Program. More information regarding Lilly Cares eligibility criteria is available at https://lillycares.com/assets/pdf/toapplycheckEligibility.pdf.
- For more information about Lilly’s privacy practices (as followed by Lilly Cares Foundation), please see the Privacy Statement.
Below you will find a list of items you will need before you start the application process. Before you start, please make sure that you have electronic copies of any required documents described below. If you do not have electronic copies of required documents available now, please fill out a paper application and fax it to Lilly Cares. A paper application is available at www.lillycares.com or by calling Lilly Cares at 1-800-545-6962. Additional program information is available on the Lilly Cares website.
Items needed for patient to complete the online application
- Personal email address.
- Correct email address for healthcare provider.
Items needed for healthcare provider to complete the online application
- Healthcare provider email address. Email address must be accessed by the healthcare provider.
- Correct email address for patient applicant.
- A signed hard copy prescription must be submitted through only one of the following options:
- uploaded with the online application
- fax to 1-844-431-6650
- electronic prescription to Fortrea Specialty Pharmacy (NPI 1780811125).
An optional prescription template for these products is available on the Resources tab of www.lillycares.com.
Please hover/click on above for more information
If prescribing a Group 4 medication for the patient (oral or infused products) and the patient has insurance that does not cover the medication, attach documentation that shows the initial claim denial and denied appeal from the insurer.