Glucagon Prescription Assistance Programs

Glucagon: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Baqsimi. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Lilly Diabetes Solution Center

(Program 1 of 3 — Scroll down to see them all )

Provided by: Lilly USA, LLC.
None
TEL: 833-808-1234
Languages Spoken:
English, Spanish
Program Website
Medications
  • Baqsimi (glucagon)
Eligibility Requirements
  • Insurance Status Contact program for details.
  • Those with Part D Elibible? Contact program for details.
  • Income Determined case by case
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Must be residing in the US or Puerto Rico
Application
  • Obtaining Call
  • Receiving Not specified
  • Returning The completed application's destination is not specified
  • Doctor's Action Varies
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Not specified
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Not specified
Additional Information
If you need help paying for your insulin, contact the Lilly Diabetes Solution Center at (833) 808-1234. Hotline staffed by medical representatives in the U.S. is available Monday through Friday, 9 a.m. to 8 p.m. Eastern time. Lilly’s lower-priced insulin is now available in U.S. pharmacies.
Updated August 16, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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Got Your BAQ Program

(Program 2 of 3 — Scroll down to see them all )

Provided by: Lilly USA, LLC.
None
TEL: 833-808-1234
ALT PHONE: 833-808-1234
Languages Spoken:
English
Program Website
Program Applications and Forms
Medications
  • Baqsimi (glucagon)
Eligibility Requirements
  • Insurance Status Must be uninsured
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Must be residing in the US or Puerto Rico
Application
  • Obtaining Anyone can enroll online
  • Receiving Must apply online
  • Returning The completed application's destination is not specified
  • Doctor's Action Not specified
  • Applicant's Action Enroll online or by phone
  • Decision Communicated Not specified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Not specified
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Contact program for details.
  • Limit Contact the program for details
  • Re-application Contact program for details.
Additional Information
Free Trial Program: Contact Program for details Program closes on 12/31/2019 Co-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients.
Updated August 16, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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Novo Nordisk Patient Assistance Program

(Program 3 of 3 — Scroll down to see them all )

Provided by: Novo Nordisk Pharmaceuticals, Inc.
PO Box 370 Somerville, NJ 08876
TEL: 866-310-7549
ALT PHONE: 866-310-7549
FAX: 866-441-4190
Languages Spoken:
English, Spanish
Program Website
Medications
  • GlucaGen Hypokit (glucagon)
Eligibility Requirements
  • Insurance Status Must be uninsured
  • Those with Part D Elibible? Contact program for details.
  • Income At or below 400% of FPL
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must be a US citizen or legal resident.
Application
  • Obtaining Call or download
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application must be faxed or mailed from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe 7-10 business days
Medication
  • Amount/Supply Up to 120 day supply
  • Sent To Doctor's office
  • Delivery Time Within 2 business days
  • Refill Proces Reorder form needs to be submitted
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
This program also provides copay assistance.
Updated July 2, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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