Lilly Maine Insulin State Patient Assistance Program™
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:
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 https://www.maine.gov/pfr/professionallicensing/professions/board-pharmacy
If you are a pharmacist in the State of Maine dispensing Urgent Needs product for LD673, the Maine Insulin Safety Net Program, visit voucheraccess.com.
- 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 https://www.maine.gov/pfr/professionallicensing/professions/board-pharmacy
If you are a pharmacist in the State of Maine dispensing Urgent Needs product for LD673, the Maine Insulin Safety Net Program, visit voucheraccess.com.
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 www.voucheraccess.com. 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:
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 https://www.maine.gov/pfr/professionallicensing/professions/board-pharmacy
To apply, please complete and submit the:
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 https://www.maine.gov/pfr/professionallicensing/professions/board-pharmacy
To apply, please complete and submit the: