Olumiant Patient Assistance Programs

Olumiant: Apply for prescription assistance below

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

PatientOne Oncology

(Program 1 of 1 — 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: 888-242-6230
Languages Spoken:
English
Program Website
Medications
  • Olumiant (baricitinib)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Not specified
  • Income At or below 500% of FPL
  • Diagnosis/Medical Criteria Must be used for on-label diagnosis
  • U.S. Residency Required? The patient must also be a US resident.
Application
  • Obtaining Call or download
  • Receiving Faxed
  • Returning The completed application must be faxed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Health care provider notified via fax
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Doctor's office
  • Delivery Time Not specified
  • Refill Proces Doctor/Doctor's office must complete replacement form
  • Limit Not specified
  • Re-application New enrollment every 12 months
Additional Information
The patient and physician must submit information to PatientOne for a benefits investigation before application will be given for the assistance program. For underinsured patients program helps connect patients with programs that can help them cover the cost of copayments and deductibles. Patients who do not have prescription insurance are reviewed for eligibility into the PatientOne patient Lilly assistance program.
Updated August 8, 2018

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