Lilly Insulin State Patient Assistance Programs

Urgent Needs Insulin Affordability Program (Call 1-866-923-1953 for more information)

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 the Voucher Access website.

Continuing Needs Lilly Colorado Insulin State Patient Assistance Program™ (Call 1-855-447-8412 for More Information)

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 the Voucher Access website.

Urgent Needs Safety Net Program (Call 1-866-923-1953 for More Information)

Pursuant to Maine law, a Maine resident is eligible to receive a 30-day urgent-need supply of insulin if an individual completes an application, which requires the individual to attest to:

• being a resident of Maine
• not being enrolled in MaineCare
• not being enrolled in any other health coverage or prescription drug coverage that limits the total amount of cost-sharing that the enrollee is required to pay for a 30-day supply of insulin, including co-payments, deductibles, or coinsurance, to $75 or less, regardless of the type or amount of insulin prescribed
• not having received an urgent-need supply of insulin through this program within the previous 12 months (unless authorized under statutory exception)
• being in urgent need of insulin

The individual must bring a completed, signed and dated application to a pharmacy. The individual must also provide a valid insulin prescription and valid identification indicating residency in the form of a valid Maine identification card, driver’s license or permit to the pharmacy.

Upon receipt of the information provided above, the pharmacist will dispense the prescribed insulin in an amount that will provide the individual a 30-day supply. If an individual does not have a valid prescription, a pharmacist may dispense an emergency refill of insulin, as outlined in the law. The pharmacy may charge up to a $35 copay for a 30-day supply of the insulin dispensed to cover the pharmacy’s costs of processing and dispensing the insulin.

Learn more at the Maine Board of Pharmacy's webpage.

If you are a pharmacist in the State of Maine dispensing Urgent Needs product for LD673, the Maine Insulin Safety Net Program, visit the Voucher Access website.

Continuing Needs Lilly Maine Insulin State Patient Assistance Program™ (Call 1-855-447-8412 for More Information)

The Lilly Maine Insulin State Patient Assistance Program™ (“Program”) provides insulin to qualifying individuals for 12 months during the Patient’s enrollment in the Program. There are two options for a Patient to receive medication through the Program. For commercially insured patients, Lilly may provide qualified individuals with a Savings Card. For all other qualified individuals, the individual’s pharmacy must order insulin from the Program through the Voucher Access website. Insulin is shipped to the enrolled individual’s pharmacy upon the receipt of the order. The pharmacy will dispense the insulin directly to the patient. In both cases, the patient may be charged up to a $50 copay for a 90-day supply of the insulin dispensed.

The individual must present their Statement of Eligibility letter provided by Lilly to their pharmacy. The individual must also present a valid insulin prescription and valid identification indicating residency in the form of a valid Maine identification card, driver’s license or permit to the pharmacy.

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

• be a Maine resident with proof of Maine residency in the form of a valid Maine issued state identification card or driver’s license or permit. If the individual is under the age of 18, the individual’s parent or legal guardian must provide proof of residency
• have a family income that is equal to or less than 400% of the federal poverty guidelines
• not be enrolled in MaineCare
• not be eligible to receive health care coverage through a federally funded program or to receive prescription drug benefits through the U.S. Department of Veterans Affairs (Note: Medicare Part D enrollees are eligible if they have spent $1,000 on prescription drugs in the current calendar year and meet the above eligibility requirements)
• 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 copayments, deductibles, or coinsurance to $75 or less, regardless of the type or amount of insulin needed

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

To apply, please complete and submit the:

• Lilly Maine Insulin State Patient Assistance Program™ Application for Adults
• Lilly Maine Insulin State Patient Assistance Program™ Application for Minors

Urgent Needs Safety Net Program (Call 1-866-923-1953 for More Information)

Pursuant to Minnesota law, a Minnesota resident is eligible to receive a 30-day urgent-need supply of insulin if an individual completes an application (accessible through the MNsure website), which requires the individual to attest to:

• being a resident of Minnesota
• not being enrolled in medical assistance or MinnesotaCare
• not being enrolled in prescription drug coverage that limits the total amount of cost-sharing that the enrollee is required to pay for a 30-day supply of insulin, including co-payments, deductibles, or coinsurance, to $75 or less, regardless of the type or amount of insulin prescribed
• not having received an urgent-need supply of insulin through this program within the previous 12 months
• being in urgent need of insulin ("urgent need of insulin" means having readily available for use less than a seven-day supply of insulin and in need of insulin in order to avoid the likelihood of suffering significant health consequences)

The individual must bring a completed, signed and dated application to a pharmacy. The individual must also provide a valid insulin prescription and valid identification to the pharmacy.

Learn more on the Minnesota Board of Pharmacy's Insulin Safety Net Program page.

If you are a pharmacist in the State of Minnesota dispensing Urgent Needs product for MNHF3100, visit the Voucher Access website.

Continuing Needs Lilly Minnesota Insulin State Patient Assistance Program™ (Call 1-855-447-8412 for More Information)

The Lilly Minnesota Insulin State Patient Assistance Program™ (“Program”) provides insulin to qualifying individuals for 12 months during the Patient’s enrollment in the Program. There are two options for a Patient to receive medication through the Program. For commercially insured Patients, Lilly may provide qualified individuals with a Savings Card. For all other qualified individuals, the individual’s pharmacy must order insulin from the Program through the Voucher Access website. Insulin is shipped to the enrolled individual’s pharmacy upon receipt of the order. The pharmacy will dispense the insulin directly to the Patient or parent/legal guardian of a Minor Patient. In both cases, the pharmacy may charge up to a $50 copay for a 90-day supply of the insulin.

The individual must bring their Statement of Eligibility letter provided by Lilly to their pharmacy. The individual must also provide a valid insulin prescription and valid identification indicating residency in the form of a valid Minnesota identification card, driver’s license or permit, or a tribal identification card to the pharmacy.

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

• be a Minnesota resident with proof of Minnesota residency in the form of a valid Minnesota issued state identification card or driver's license or permit, or tribal identification card. If the individual is under the age of 18, the individual's parent or legal guardian must provide proof of residency
• have a family income that is equal to or less than 400% of the federal poverty guidelines
• not be enrolled in medical assistance or MinnesotaCare
• not be eligible to receive health care through a federally-funded program or receive prescription drug benefits through the U.S. Department of Veterans Affairs (Note: Medicare Part D enrollees are eligible if they have spent $1,000 on prescription drug coverage and meet the first three eligibility requirements above.)
• 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 $75 or less, regardless of the type or amount of insulin needed

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

To apply, please complete and submit the:

• Lilly Minnesota Insulin State Patient Assistance Program™ Application for Adults
• Lilly Minnesota Insulin State Patient Assistance Program™ Application for Minors