Basaglar

Indicated For

Type 1 diabetes, Type 2 diabetes

About This Medication

# Lilly Cares Foundation Patient Guide: How to Get Basaglar at Low or No Cost ## About This Program The **Lilly Cares Foundation Patient Assistance Program** helps eligible patients access **Basaglar (insulin glargine)** and other Eli Lilly medications at no cost or reduced cost. If you struggle to afford your insulin, this program may be able to help you get the medication you need to manage your diabetes. ## Who Qualifies for Lilly Cares To be eligible for the Lilly Cares program, you must meet several requirements: **Residency:** You must be a permanent resident of the United States, including Puerto Rico and the U.S. Virgin Islands. **Prescription Requirement:** Your healthcare provider must have prescribed Basaglar or another medication covered by Lilly Cares. **Insurance Status:** Your insurance coverage must meet specific requirements. You may qualify if you are: - Uninsured - Privately insured but your plan does not cover Basaglar - Enrolled in Medicare Part D (with certain restrictions) You generally cannot qualify if you are enrolled in Medicaid or receive full Low Income Subsidy ("Extra Help") or Veterans (VA) Benefits. ## Income Eligibility Your household income must fall within the program's guidelines. The income thresholds vary based on household size: | Household Size | Maximum Annual Income | |---|---| | Individual | $50,000 | | Couple (2 people) | $70,000 | | Family of 4 | $200,000 | | Larger families | Up to $200,000 depending on composition | These guidelines are based on federal poverty level calculations and may be adjusted annually. If your household income exceeds these thresholds, you may still qualify depending on your specific circumstances—contact Lilly Cares to discuss your situation. ## How to Apply for Basaglar Assistance **Step 1: Choose Your Application Method** You have three options for completing your application: - **Online application** (recommended): Reduces paperwork and potential delays - **Printed paper application**: Download, print, and fill out by hand - **Computer-filled application**: Download, complete on your computer, then print To request an application by mail, call **1-800-545-6962**. **Step 2: Complete Your Patient Section** Fill out all required information on the patient section of the application, including: - Your full name and address - Date of birth - Contact information - Household income details - Insurance information - Proof that you meet the program's income guidelines **Step 3: Have Your Doctor Complete the Prescriber Section** Your healthcare provider must: - Complete the prescriber section of the application - Confirm that Basaglar has been prescribed for you - Submit a current prescription - Sign and date the form Work with your doctor's office to ensure this section is completed promptly, as incomplete applications may be delayed. **Step 4: Gather Supporting Documents** Include proof of your household income, such as: - Recent tax returns - Pay stubs - Proof of benefits - Other income documentation Also include any insurance documents that show your coverage status. **Step 5: Submit Your Application** Submit your completed application using one of these methods: - **Online submission** (fastest): Complete the online application directly - **Mail**: Send to: - Lilly Cares Patient Assistance Program - PO Box 501847 - San Diego, CA 92150 - **Fax**: Contact 1-800-545-6962 for the fax number ## Timeline and What to Expect **Processing Time:** Your application typically takes **2-4 weeks** to review. Processing may take longer if documents are incomplete or missing. **Notification:** You will receive notification of the enrollment decision by: - Mail to your home address - Text message (if applicable) - Your healthcare provider will receive a fax notification **Approval Duration:** If approved, your enrollment generally lasts **12 months** or until the end of the calendar year (for Medicare Part D patients). **Medication Delivery:** Once approved, your Basaglar will be: - Shipped directly to your home, or - Sent to your healthcare provider's office Our pharmacy partner will contact you to schedule delivery if applicable. ## Reauthorization and Refills **Annual Reapplication Required:** At the end of your 12-month enrollment period, you must reapply to continue receiving assistance through Lilly Cares. **Medicare Part D Patients:** If you receive Medicare Part D and use self-administered medications, you can begin reapplying for the upcoming year starting **October 15**. You are encouraged to reapply by **December 31** to ensure continuous coverage. **Refills:** Contact Lilly Cares at **1-800-545-6962** to request medication refills during your enrollment period. ## What If Your Application Is Denied? If your application is not approved, you have several options: - **Contact Lilly Cares** to understand why your application was denied and whether you can provide additional information - **Reapply** if your circumstances change (such as a change in income or insurance status) - **Explore other assistance programs** through your healthcare provider, local health departments, or nonprofit organizations that help with medication costs - **Discuss alternative medications** with your doctor that may be covered by your insurance or other assistance programs ## Important Reminders **No Application Fees:** Lilly Cares does not charge patients any fees for help with enrollment, medication refills, or program participation. Be cautious of third-party services that charge fees for assistance that Lilly Cares provides at no cost. **Accurate Information:** Double-check all details on your application to avoid delays. Incomplete or inaccurate information may result in denial or processing delays. **Stay in Contact:** Keep your contact information current with Lilly Cares so you receive important notifications about your enrollment status and medication delivery. ## Contact Information For questions about the Lilly Cares Foundation Patient Assistance Program: - **Phone:** 1-800-545-6962 - **Website:** www.LillyCares.com ## Disclaimer This guide provides general information about the Lilly Cares Foundation Patient Assistance Program. Program eligibility, requirements, and benefits may change. For the most current and complete information, visit www.LillyCares.com or call 1-800-545-6962. This guide is not a guarantee of program eligibility or approval. Your individual circumstances will be evaluated during the application review process.

Program information last verified: March 30, 2026