Lilly Colorado Insulin State Patient Assistance Program™

Pursuant to Colorado law, a Colorado resident is eligible to receive a 30-day urgent-need supply of insulin once per 12-month period for no more than $35 if an individual completes an application (accessible through the Colorado Board of Pharmacy website), which requires the individual to:

• be a resident of Colorado

• have a valid prescription for insulin or be eligible for an emergency supply

• have less than a 7-day supply of insulin available

• be required to pay more than $100 out-of-pocket each month for the individual’s insulin

Learn more on the Colorado Board of Pharmacy's Insulin Affordability Program page.

If you are a pharmacist in the State of Colorado dispensing Urgent Needs product for HB 21-1307, visit www.voucheraccess.com.

The Lilly Colorado Insulin State Patient Assistance Program™ (“Program”) provides insulin to qualifying individuals for 12 months during the Patient’s enrollment in the Program. The individual’s pharmacy must order insulin from the Program. Insulin is shipped to the enrolled individual’s pharmacy upon receipt of the order.

Pursuant to Colorado law, to be eligible to participate in the Lilly Colorado Insulin State Patient Assistance Program™, the individual must:

• be a permanent, legal resident of the state of Colorado

• not be eligible for or enrolled in assistance provided through the “Colorado Medical Assistance Act”, Articles 4 to 6 of Title 25.5, or the Federal “Health Insurance for the Aged Act”, Title XVIII of the Federal “Social Security Act”, 42 U.S.C. sec 1395 et seq, as amended

• have a valid insulin prescription

• not be enrolled in prescription drug coverage through an individual or group health plan that limits the total amount of cost-sharing that an enrollee is required to pay for a 30-day supply of insulin, including co-payments, deductibles, or coinsurance to $100 or less, regardless of the type or amount of insulin needed

• The individual must present, at a pharmacy, a completed, signed, and dated application form with proof of the individual’s Colorado residency. If the individual is under 18 years of age, the individual’s parent or legal guardian may provide the pharmacist with proof of residency

For those interested in learning more about this program, please contact the Lilly Colorado Insulin State Patient Assistance Program™ at 1-855-447-8412 or learn more on the Colorado Board of Pharmacy's Insulin Safety Net Program page.

If you are a pharmacist in the State of Colorado dispensing Continuing Needs product for HB 21-1307, visit www.voucheraccess.com.