Eli Lilly www.lilly.ca

Lilly Canada Patient Assistance Program

This program provides free-of-charge medication to eligible patients for a limited period of time. Each application is approved for a 6-month period (6 months of supply provided for qualifying patients). A 6-month supply will be shipped to physician’s office within 3-4 business days following approval. Re-application is required every 6 months if further assistance is needed.

It appears that each physician is limited to having 6 patients on the Patient Assistance Program.

Applies to all molecules that Lilly makes.

Fax completed form to: 1-877-691-8866

To check on status of a claim:
Pharmacist's information in processing Byetta coverage. With Claim Secure card given to patient by physician (received from rep), patient eligible for 1 month supply of Byetta. Subsequently, patient may obtain 80% coverage for 3 month extension by contacting RxHelp: www. HbcRxHelp.com/Byetta