Humalog u-100 Prescription Assistance Programs

Humalog u-100: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Humalog U-100. 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 or go to the program website.

Looking for a different medication?

Lilly Cares Foundation Patient Assistance Program

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

Provided by: Lilly USA, LLC.
PO Box 13185 La Jolla, CA 92039
TEL: 800-545-6962
FAX: 844-431-6650
Languages Spoken:
English, Spanish
Program Website
  • Humalog U-100 (insulin lispro)
Eligibility Requirements
  • Insurance Status *Contact program for details.
  • Those with Part D Elibible? Varies
  • Income Varies
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must also be residing in the US or Puerto Rico
  • Obtaining Call, download or apply online
  • Receiving Faxed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Not specified
  • Amount/Supply Up to 120 day supply
  • Sent To Varies
  • Delivery Time Contact Program for Details
  • Refill Proces Contact program for details.
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
Please visit or call 800-545-6962 for more information. Additional products may be available. Please contact the program for a complete product listing. Lilly donates products to the Lilly Cares Foundation Patient Assistance Program.
Updated December 9, 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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