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Program Details

Lilly Cares

Cymbalta (duloxetine hcl)
Address: PO Box 13185
La Jolla, CA 92039
Phone: 1-800-545-6962 Provider Phone:
Fax: 1-844-431-6650 Website: Program Website
Eligibility Info:
  • Patient must be uninsured or have Medicare Part D.
  • Patients may be eligible if insurance does not cover their medication. Contact program for details.
  • Patients must not be eligible for or enrolled in Medicaid or Veterans Administration Benefits.
  • Contact program for additional details. (Note: Humatrope patients with VA and Medicaid benefits may be eligible.)
  • Income at or below: Not Published
    Other Income Requirements: Income limits vary by medication. Contact program for details.
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    Attachments Required: Financial
    Physician License #
    Prescriber Signature
    Application may be
    Eligibility determination
    letter sent:
    Both Provider and Patient
    Receives: Medication
    Shipped To: Either Provider and Patient
    Quantity in Shipment: Up to a 120-day supply
    Delivery Time: Not Published
    Re-application Policy: New application every 12 months
    New financial information every 12 months
    Refill Policy: Contact program
    Other Information:

    Last Updated: 04/26/2023




    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.

    DocumentForm (English)

    Document Form (Spanish)


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