Glucagon Patient Assistance Programs

Glucagon: Apply for prescription assistance below

If you are eligible, the programs below can help you afford glucagon. 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?

HealthWell Foundation Copay Program

(Program 1 of 6 — Scroll down to see them all)

Provided by: HealthWell Foundation
PO Box 220410 Chantilly, VA 20153-0410
TEL: 800-675-8416
FAX: 800-282-7692
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • None (glucagon)
Eligibility Requirements
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income Varies
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must also be residing in the US.
Application
  • Obtaining Call or complete online
  • Receiving Sent out or may be completed online
  • Returning The completed application must be mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient notified in writing
  • Decision Timeframe 3-5 business days
Medication
  • Amount/Supply Not applicable
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Good for one year
  • Limit Not specified
  • Re-application New application every 12 months
Additional Information
This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. Call for most recent medications as the list is subject to change.
Updated January 3, 2018

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

Back to top

Lilly Cares Patient Assistance Program

(Program 2 of 6 — Scroll down to see them all)

Provided by: The Lilly Cares Foundation, Inc.
PO Box 13185 La Jolla, CA 92039
TEL: 800-545-6962
FAX: 844-431-6650
Languages Spoken:
English
Program Website
Medications
  • Glucagon injection (glucagon injection)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? Determined case by case
  • Income Varies
  • Diagnosis/Medical Criteria Must be under 65 years of age
  • U.S. Residency Required? Puerto Rico & US Virgin Island residents are not eligible
Application
  • Obtaining Call or download
  • Receiving Faxed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient notified of denial in writing
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Up to 120 day supply
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces Refill/reorder form included with shipment
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
None
Updated August 8, 2018

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

Back to top

Lilly Cares Patient Assistance Program

(Program 3 of 6 — Scroll down to see them all)

Provided by: The Lilly Cares Foundation, Inc.
PO Box 13185 La Jolla, CA 92039
TEL: 800-545-6962
FAX: 844-431-6650
Languages Spoken:
English
Program Website
Medications
  • Glucagon injection (glucagon injection)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? Determined case by case
  • Income Varies
  • Diagnosis/Medical Criteria Must be under 65 years of age
  • U.S. Residency Required? Puerto Rico & US Virgin Island residents are not eligible
Application
  • Obtaining Call or download
  • Receiving Faxed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient notified of denial in writing
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Up to 120 day supply
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces Refill/reorder form included with shipment
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
None
Updated August 8, 2018

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

Back to top

Lilly Cares Patient Assistance Program

(Program 4 of 6 — Scroll down to see them all)

Provided by: The Lilly Cares Foundation, Inc.
PO Box 13185 La Jolla, CA 92039
TEL: 800-545-6962
FAX: 844-431-6650
Languages Spoken:
English
Program Website
Medications
  • Glucagon injection (glucagon injection)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? Determined case by case
  • Income Varies
  • Diagnosis/Medical Criteria Must be under 65 years of age
  • U.S. Residency Required? Puerto Rico & US Virgin Island residents are not eligible
Application
  • Obtaining Call or download
  • Receiving Faxed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient notified of denial in writing
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Up to 120 day supply
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces Refill/reorder form included with shipment
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
None
Updated August 8, 2018

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

Back to top

Lilly Cares Patient Assistance Program

(Program 5 of 6 — Scroll down to see them all)

Provided by: The Lilly Cares Foundation, Inc.
PO Box 13185 La Jolla, CA 92039
TEL: 800-545-6962
FAX: 844-431-6650
Languages Spoken:
English
Program Website
Medications
  • Glucagon injection (glucagon injection)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? Determined case by case
  • Income Varies
  • Diagnosis/Medical Criteria Must be under 65 years of age
  • U.S. Residency Required? Puerto Rico & US Virgin Island residents are not eligible
Application
  • Obtaining Call or download
  • Receiving Faxed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient notified of denial in writing
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Up to 120 day supply
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces Refill/reorder form included with shipment
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
None
Updated August 8, 2018

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

Back to top

Novo Nordisk Patient Assistance Program

(Program 6 of 6 — 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? Yes, but contact program for details
  • Income At or below 300% 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 August 10, 2018

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

Back to top