Registered Users Log-in:

E-mail Address:


Forgot Password?
Patient Assistance Information

1 Program for Zyprexa Zydis tablet; orally disintegrating
Lilly Cares Patient Assistance Program

Lilly Cares Program
PO Box 230999
Centerville, VA 20120
Phone : 800-545-6962
Fax: 844-431-6650
> This program is intended for patients that are uninsured. Medicare Part D patients eligibility is determined case by case. Patient must be under 65 years of age. Income requirements for this program vary. Must be a US citizen, Puerto Rico & US Virgin Island residents are not eligible.
Who Can Apply
> Anyone requesting assistance can call to request a faxed application or download it from the website. If denied the Patient will be notified in writing.
> The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach required documents.
> Up to a 120-day supply.
Ship To
> Medication is sent to the Doctor's office within 4 weeks.
> A refill/reorder form is included with each shipment that must be filled out and returned to get the next shipment. Once a year a new application with financial documentation is needed.
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
Zyprexa Zydis tablet; orally disintegrating
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form Lilly Cares Patient Assistance Program
(Requires Acrobat Reader