If you qualify for the Lilly Cares program, a 120-day supply of medicine will be shipped to your health care provider's office for you to pick up. Prescription refills will be available during your 1-year enrollment period. For refills, please complete and submit the fax refill form.

How to Apply

Please either download the application below (if available) or go to the program website for more information on how to apply. Once you fill out your application, send it to the address on the application. Remember not to send program applications to the PPA.

Product(s) Covered by Program

  • C

    • Cialis® (tadalafil) tablets
    • Cymbalta® (duloxetine) delayed release capsules
  • E

    • Effient® (prasugrel) tablets
    • Evista® (raloxifene hydrochloride) tablets
  • G

    • Glucagon™ (glucagon for injection [rDNA origin])
  • H

    • Humalog® (insulin lispro injection USP [rDNA origin])
    • Humalog® Mix 50/50™ (50% Insulin lispro protamine suspension, 50% insulin lispro injection [rDNA origin])
    • Humalog® Mix 75/25™ (75% Insulin lispro protamine suspension, 25% insulin lispro injection [rDNA origin])
    • Humulin® 70/30 (70% human insulin isophane suspension, 30% human insulin injection [rDNA origin])
    • Humulin® N (NPH human insulin [rDNA origin] isophane suspension)
    • Humulin® R (U-100) (regular insulin human injection, USP [rDNA origin])
    • Humulin® R (U-500) (regular U-500 [concentrated] insulin human injection, USP [rDNA origin])
  • P

    • Prozac® (fluoxetine)
  • Q

    • Quinidine Gluconate, Injection, USP
  • R

    • ReoPro® (abciximab)
  • S

    • Strattera® (atomoxetine) capsules
    • Symbyax® (olanzapine and fluoxetine) capsules
  • T

    • Trulicity™ (dulaglutide) injection
  • Z

    • Zyprexa® (olanzapine) tablets
    • Zyprexa® Relprevv™ (olanzapine for extended release injectable suspension)
    • Zyprexa® Zydis® (olanzapine orally disintegrating tablets)