Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. HealthWell Foundation Copay Program Enrollment: Contact programįDA Approved Diagnosis - See Program Website for Details HealthWell Foundation Copay Program This is a copay assistance program Some medications are available for a fee of $20 for up to a 180 day supply.Ĭheck the Rx Outreach website for the exact price and most current medication list.Ĭontact Program for Spanish Application(s)/Form(s). Rx Outreach Diabetic Supplies Order Form: Prodigy (Spanish) Rx Outreach Diabetic Supplies Order Form: Prodigy Rx Outreach Medication List (by Disease State) (Spanish) Rx Outreach Medication List (by Disease State) (Most brand names are provided for reference purposes only) Rx Outreach Medications This program provides medication at low cost. Lilly donates products to the Lilly Cares Foundation Patient Assistance Program. Please contact the program for a complete product listing. Please visit or call (800) 545-6962 for more information.Īdditional products may be available. New application, new documentation yearly Must be US citizen or a legal permanent resident of the USĬomplete section, sign, attach required documents Lilly Cares Foundation Patient Assistance Program Application (Spanish) Lilly Cares Foundation Patient Assistance Program Application Lilly Cares Foundation Patient Assistance Program This program provides medication at no cost.
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