EBGLYSS

Indicated For

moderate-to-severe atopic dermatitis

About This Medication

# Lilly Cares Foundation Patient Guide: How to Get EBGLYSS at Low or No Cost ## About This Program The **Lilly Cares Foundation Patient Assistance Program** helps eligible patients receive **EBGLYSS (lebrikizumab-lbkz)** at no cost if they cannot afford their medication. This program is provided by Eli Lilly and does not charge patients any fees for enrollment, medication refills, or program participation. ## Who Can Qualify for EBGLYSS Through Lilly Cares To be eligible for this program, you must meet all of the following requirements: - **U.S. Residency:** You must be a permanent resident of the United States, including Puerto Rico and the U.S. Virgin Islands - **Valid Prescription:** Your healthcare provider must have prescribed EBGLYSS - **Insurance Status:** You must be uninsured or underinsured. Patients with certain types of insurance may not qualify - **Income Requirements:** Your household income must fall within the program's guidelines - **Not Enrolled in Certain Programs:** You cannot be enrolled in Medicaid, full Low Income Subsidy (LIS/"Extra Help"), or Veterans (VA) Benefits ## Understanding Income Eligibility The Lilly Cares program uses **300% of the Federal Poverty Level** as its income threshold. This means your annual household income must be at or below this limit to qualify. | Household Size | 2026 Federal Poverty Level | 300% of FPL (Eligibility Limit) | |---|---|---| | Individual | ~$15,060 | ~$45,180 | | Family of 2 | ~$20,440 | ~$61,320 | | Family of 3 | ~$25,820 | ~$77,460 | | Family of 4 | ~$31,200 | ~$93,600 | *Note: These figures are approximate and based on 2026 guidelines. Contact Lilly Cares for current income limits.* ## Insurance Requirements Explained You are generally eligible if you are: - **Uninsured** (have no health insurance coverage) - **Underinsured** (have insurance but it doesn't cover EBGLYSS or your out-of-pocket costs are too high) You are **not eligible** if you have: - Medicaid coverage - Full Low Income Subsidy (LIS) or "Extra Help" benefits - Veterans (VA) Benefits Some patients with **Medicare Part D** may qualify, depending on their specific coverage situation. Contact the program to discuss your insurance status. ## How to Apply for EBGLYSS Assistance ### Step 1: Choose Your Application Method You can apply in three ways: 1. **Online Application** (Recommended) - Fastest option with less paperwork and fewer delays 2. **Printed Paper Application** - Download, print, and fill out by hand 3. **Computer-Filled Application** - Download, fill out on your computer, then print To request an application by mail, call **1-800-545-6962**. ### Step 2: Gather Required Documents Before starting your application, collect: - **Proof of Income:** Recent tax returns, pay stubs, or other income documentation - **Insurance Information:** Details about your current health insurance (or confirmation that you're uninsured) - **Doctor's Information:** Your prescribing physician's name, address, and contact information - **Personal Information:** Your name, address, date of birth, and contact details ### Step 3: Complete Your Application **Patient Section:** - Fill out all personal information accurately - Report your household income and family size - Describe your insurance coverage (or lack thereof) - Sign and date the application **Doctor's Section:** - Your healthcare provider must complete the prescriber section - Your doctor will submit a current prescription for EBGLYSS - Your doctor must sign the application ### Step 4: Submit Your Application Submit your completed application using one of these methods: - **Online:** Submit through the Lilly Cares online portal (fastest processing) - **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 Applications typically take **2-4 weeks** to process. You will receive notification of the enrollment decision by: - **Mail** to your home address - **Text message** (if you provided a cell phone number) - **Fax** to your healthcare provider's office ### After Approval If your application is approved: - You will receive an **enrollment notification letter** that includes your enrollment expiration date (typically 12 months, or at the end of the calendar year for Medicare Part D patients) - Your EBGLYSS will be **shipped to your home or your doctor's office** - The pharmacy partner will call you to schedule delivery if applicable - You can begin receiving your medication ### Reapplication Requirements Your enrollment is **not automatic**. At the end of your enrollment period, you must **reapply to continue receiving assistance**. Medicare Part D patients can begin reapplying on **October 15** for the upcoming year and should reapply by **December 31**. ## What If Your Application Is Denied? If your application is not approved, you have several options: - **Contact Lilly Cares** at **1-800-545-6962** to understand why you were denied and whether you can provide additional information - **Reapply** if your circumstances change (such as income reduction or insurance status change) - **Explore Other Assistance:** Ask your doctor about other patient assistance programs, state pharmaceutical assistance programs, or nonprofit organizations that help with medication costs - **Discuss with Your Doctor:** Your healthcare provider may have information about alternative medications or other resources ## Important Reminders - **No Fees:** Lilly Cares does not charge patients for help with enrollment, medication refills, or program participation - **Beware of Third Parties:** Do not use third-party services that charge fees for assistance that Lilly Cares provides for free - **Annual Reapplication:** You must reapply each year to continue receiving EBGLYSS - **Keep Information Current:** Update Lilly Cares if your income, insurance, or contact information changes ## Contact Information **Lilly Cares Foundation Patient Assistance Program** - **Phone:** 1-800-545-6962 - **Mailing Address:** PO Box 501847, San Diego, CA 92150 - **Website:** www.LillyCares.com ## Disclaimer This guide provides general information about the Lilly Cares Foundation Patient Assistance Program for EBGLYSS. Program eligibility, requirements, and benefits may change. For the most current and accurate information, please contact Lilly Cares directly at 1-800-545-6962 or visit www.LillyCares.com. This information is not a guarantee of enrollment or medication provision. Always consult with your healthcare provider about your treatment options and medication assistance.

Program information last verified: March 30, 2026