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A GUIDE TO THE LILLY CARES FOUNDATION PATIENT ASSISTANCE PROGRAM

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A GUIDE TO THE LILLY CARES FOUNDATION

PATIENT ASSISTANCE PROGRAM

PP-AP-US-0250 08/2017 PRINTED IN USA ©Lilly USA, LLC 2017 All rights reserved.

The Lilly Cares Foundation, Inc., a separate nonprofit organization, offers assistance to patients in need by providing Lilly medications through its patient assistance program, the Lilly Cares Foundation Patient Assistance Program.

The Lilly Cares Foundation, Inc. is committed to assisting those in need with obtaining free Lilly medication.

Since 2012, the Lilly Cares Foundation has helped more than one million patients in the U.S. obtain Lilly medications.

For detailed information about the Lilly Cares Foundation Patient Assistance Program eligibility requirements, available medications, or an application, visit www.LillyCares.com, or call us directly at 1-800-545-6962.

Lilly Cares Foundation Patient Assistance ProgramThe Lilly Cares Foundation Patient Assistance program assists eligible patients with obtaining access to most of Lilly’s medications for autoimmune, mental health, men’s health, osteoporosis, oncology, and diabetes, offered free through the Lilly Cares Foundation Patient Assistance Program.

QualificationsMost Lilly products are available through the Lilly Cares Foundation Patient Assistance Program.

You may be eligible for assistance if*:

» You have been prescribed a Lillymedication that is offered throughour program

» You are a permanent, legal US resident

» You meet the income requirements

* These are just some of the eligibility requirements.Lilly Cares may need additional information tomake sure a patient is eligible for the program.

How to request the assistance you needIf you think you may qualify for the Lilly Cares Foundation Patient Assistance Program, contact the program directly to get an application. To apply, submit your completed application and the required documents.The Lilly Cares Foundation Patient Assistance program does not charge a fee for participation. If you are approved, you will receive your medication in about 2 weeks. Once you are enrolled, you will remain enrolled for up to 12 months. You will continue to receive your free medications unless your eligibility changes (for example, if your insurance status or income changes). At the end of the enrollment period, you must reapply to remain eligible in the program.

A GUIDE TO THE LILLY CARES FOUNDATION

PATIENT ASSISTANCE PROGRAM

PP-AP-US-0249 08/2017 PRINTED IN USA ©Lilly USA, LLC 2017 All rights reserved.

The Lilly Cares Foundation, Inc., a separate nonprofit organization, offers assistance to patients in need by providing Lilly medications through its patient assistance program, the Lilly Cares Foundation Patient Assistance Program.

The Lilly Cares Foundation, Inc. is committed to assisting those in need with obtaining free Lilly medication.

Since 2012, the Lilly Cares Foundation has helped more than one million patients in the U.S. obtain Lilly medications. For detailed information about the Lilly Cares Foundation Patient Assistance Program eligibility requirements, available medications, or an application, visit www.LillyCares.com, or call us directly at 1-800-545-6962.

Lilly Cares Foundation Patient Assistance ProgramThe Lilly Cares Foundation Patient Assistance program assists eligible patients with obtaining access to most of Lilly’s medications for autoimmune, mental health, men’s health, osteoporosis, oncology, and diabetes, offered free through the Lilly Cares Foundation Patient Assistance Program.

QualificationsMost Lilly products are available through the Lilly Cares Foundation Patient Assistance Program.

You may be eligible for assistance if*:

» You have been prescribed a Lilly medication that is offered through our program

» You are a permanent, legal US resident

» You meet the income requirements

* These are just some of the eligibility requirements. Lilly Cares may need additional information to make sure a patient is eligible for the program.

How to request the assistance you needIf you think you may qualify for the Lilly Cares Foundation Patient Assistance Program, contact the program directly to get an application. To apply, submit your completed application and the required documents.The Lilly Cares Foundation Patient Assistance program does not charge a fee for participation. If you are approved, you will receive your medication in about 2 weeks. Once you are enrolled, you will remain enrolled for up to 12 months. You will continue to receive your free medications unless your eligibility changes (for example, if your insurance status or income changes). At the end of the enrollment period, you must reapply to remain eligible in the program.

The Lilly Cares Foundation, Inc. is committed to assisting those in need with obtaining free Lilly medication.

Since 2012, the Lilly Cares Foundation has helped more than one million patients in the U.S. obtain Lilly medications. For detailed information about the Lilly Cares Foundation Patient Assistance Program eligibility requirements, available medications, or an application, visit www.LillyCares.com, or call us directly at 1-800-545-6962.

Lilly Cares Foundation Patient Assistance ProgramThe Lilly Cares Foundation Patient Assistance program assists eligible patients with obtaining access to most of Lilly’s medications for autoimmune, mental health, men’s health, osteoporosis, oncology, and diabetes, offered free through the Lilly Cares Foundation Patient Assistance Program.

QualificationsMost Lilly products are available through the Lilly Cares Foundation Patient Assistance Program.

You may be eligible for assistance if*:

» You have been prescribed a Lilly medication that is offered through our program

» You are a permanent, legal US resident

» You meet the income requirements

* These are just some of the eligibility requirements. Lilly Cares may need additional information to make sure a patient is eligible for the program.

How to request the assistance you needIf you think you may qualify for the Lilly Cares Foundation Patient Assistance Program, contact the program directly to get an application. To apply, submit your completed application and the required documents.The Lilly Cares Foundation Patient Assistance program does not charge a fee for participation. If you are approved, you will receive your medication in about 2 weeks. Once you are enrolled, you will remain enrolled for up to 12 months. You will continue to receive your free medications unless your eligibility changes (for example, if your insurance status or income changes). At the end of the enrollment period, you must reapply to remain eligible in the program.

A GUIDE TO THE LILLY CARES FOUNDATION

A TIET A SSISTANCE PROGRAM

PP-AP-US-0250 08/2017 ©Lilly USA, LLC 2017 All rights reserved.

The Lilly Cares Foundation, Inc., a separate nonprofit organization, offers assistance to patients in need by providing Lilly medications through its patient assistance program, the Lilly Cares Foundation Patient Assistance Program.