• Contact us at 1-800-545-6962 Mon-Fri 8am-5pm EST, Oncology 9am-7pm EST
Resources
Lilly Cares Foundation Patient Assistance Program application
Lilly Cares Foundation Patient Assistance Program Oncology application

Lilly Cares Foundation Patient Assistance Program brochure:
If you know someone who may benefit from the Lilly Cares Foundation Patient Assistance Program, this brochure provides our toll-free number and website information.
Prescription Fax Form templates or refills for a Lilly Cares product:
The healthcare provider may use these optional Prescription Fax form templates when prescribing Forteo®, Humalog® Junior KwikPen®, Humulin® R U-500, Humatrope®, Taltz®, or when ordering refills for a Lilly Cares product.

Forteo Prescription Fax Form when ordering Forteo.
Humalog Junior KwikPen Fax Form when ordering Humalog Junior KwikPen.
Humatrope Prescription Fax Form when ordering Humatrope.
Humulin R U-500 Prescription Fax Form when ordering Humulin R U-500.
Taltz Prescription Fax Form when ordering Taltz.

Lilly Cares Fax Refill Order Form when ordering refills (excluding Forteo, Humatrope, Taltz) for enrolled Lilly Cares Patients.
Lilly Cares Oncology Forms:

Dose Tracking/Administration Form