Resources

Financial Assistance

Update your billing and coding systems to include the permanent CYRAMZA® (ramucirumab) J-code: J9308, injection, ramucirumab, 5 mg. Issued by the Centers for Medicare & Medicaid Services (CMS), this permanent J-code is effective as of January 1, 2016.

Resources

Financial Assistance

Lilly PatientOne Co-pay Program

Eligible patients can lower their co-pay or coinsurance costs by paying no more than $25 per dose.* Program is not based on patient income.

This offer is invalid for patients whose prescription claims are eligible to be reimbursed, in whole or in part, by any governmental program.

Program Overview Eligibility Requirements
Patient responsibility
ALIMTA® (pemetrexed for injection), CYRAMZA® (ramucirumab), ERBITUX® (cetuximab), LARTRUVO (olaratumab), Portrazza® (necitumumab)
Patient pays no more than $25 per dose.
Maximum patient benefit
ALIMTA, CYRAMZA, ERBITUX, LARTRUVO, Portrazza
$25,000 per 12-month period
Eligibility requirements
  • Patient is age 18 years or older
  • Patient must have proof of residency in the United States or Puerto Rico
  • Patients must be treated with ALIMTA® (pemetrexed for injection), CYRAMZA® (ramucirumab), ERBITUX® (cetuximab), LARTRUVO™ (olaratumab), or Portrazza® (necitumumab) for an FDA-approved indication
  • Patient must be commercially insured

† This includes patients enrolled in health insurance exchange plans. This offer is invalid for patients whose prescription claims for ALIMTA, CYRAMZA, ERBITUX, LARTRUVO, or Portrazza are eligible to be reimbursed, in whole or in part, by any governmental program, including, without limitation, Medicaid, Medicare, Medigap, CHAMPUS, DOD, VA, TRICARE, or any state patient, or pharmaceutical assistance program. Additional program restrictions apply. Please see full Terms and Conditions.

Additional information
  • The Program may provide support for treatment with a date of service that falls within 120 days prior to the date the application is received by the program
  • For enrolled patients, a claim for reimbursement must be submitted within 180 days of infusion to receive program benefits
  • Maximum annual benefit of $25,000

Patient enrollment steps

1 Review program eligibility with your patient based upon the full criteria listed on the application.
2 Click here to download an application form or call Lilly PatientOne at 1-866-4PatOne (1-866-472-8663) for a faxed copy.
3 Fax the completed application to 1-877-366-0585.
4 Your patient’s application will be reviewed to determine eligibility.

What you and your patients can expect next

  • Approved patients will receive an enrollment letter and their co-pay card in the mail
  • Your office will be informed, through a faxed letter, of your patient’s enrollment status and provided with direction to submit a claim for financial assistance

For more information, please call 1-866-4PatOne (1-866-472-8663).

Sometimes insurance isn’t enough to pay for cancer treatment.

Independent Patient Assistance Charitable Foundations

There may be a way to help your underinsured patients get the treatment they need with less financial stress. If your patients can’t afford their co-pay or coinsurance, Lilly PatientOne provides information about a number of independent patient assistance charitable foundations that may be able to help. These foundations are not affiliated with Eli Lilly and Company and have been established and are operated independently. Each foundation provides foundation-specific support for eligible patients. Please remember, funding availability changes weekly. Contact a Lilly PatientOne representative at 1-866-4PatOne (1-866-472-8663) or each foundation for current information.

View charitable foundations list

Lilly Cares Foundation, Inc.

The Lilly Cares Foundation, Inc., a separate nonprofit organization, provides free Lilly medications to qualifying patients. For more information about Lilly Cares, please visit LillyCares.com.

Financial assistance is limited to the co-pay or coinsurance costs for doses of ALIMTA, CYRAMZA, ERBITUX, LARTRUVO, or Portrazza and does not cover any additional costs, including, but not limited to, fees related to the administration of ALIMTA, CYRAMZA, ERBITUX, LARTRUVO, or Portrazza.

† Additional patient terms and conditions will apply. See below for details.

Lilly PatientOne Co-pay Program Terms and Conditions (Effective June 1, 2017)

Eligibility: (1) You have been prescribed one of the following Lilly Oncology medicines covered by the Lilly PatientOne Co-pay Program (“Program”): Alimta® (pemetrexed for injection), Cyramza® (ramucirumab), Erbitux® (cetuximab), Portrazza® (necitumumab), or Lartruvo (olaratumab) (hereinafter collectively referred to as “prescribed Lilly Oncology medicine”). (2) You have commercial insurance that covers your prescribed Lilly Oncology medicine, but your insurance does not cover the full cost; that is, you have a co-pay or coinsurance obligation. (3) You are not participating in any state or federal healthcare program, including, without limitation, Medicaid, Medicare, Medigap, CHAMPUS, DOD, VA, TRICARE, or any state patient, or pharmaceutical assistance program; patients who move from commercial insurance to a state or federal healthcare program will no longer be eligible. (4) You are 18 years of age or older and are receiving your prescribed Lilly Oncology medicine for an FDA-approved use. Please ask your doctor for information about FDA-approved uses. Also see your doctor for the full US Prescribing Information for your prescribed Lilly Oncology medicine. (5) You are a resident of the United States or Puerto Rico.

Program Benefits: (6) The patient must first pay a portion of his or her co-pay or coinsurance ($25 for each dose of the patient’s prescribed Lilly Oncology medicine). The Program will cover the remainder of the patient’s co-pay or coinsurance for the prescribed Lilly Oncology medicine, up to a maximum of $25,000 during a 12-month enrollment period. (7) In order to receive Program benefits, the patient or healthcare provider must submit an Explanation of Payment (EOP) form. The submitted form must include the name of the insurer and plan, and show that the prescribed Lilly Oncology medicine was the medication that was administered. (8) For enrolled patients, a claim for reimbursement must be submitted within 180 days of infusion to receive Program benefits. (9) Program benefits are limited to the co-pay or coinsurance costs for doses of the prescribed Lilly Oncology medicine only. The Program will not cover, and shall not be applied toward, the cost of any dosing procedure, any other healthcare provider service or supply charges or other treatment costs, or any costs associated with a hospital stay. (10) For enrolled patients, the Program may provide support for doses with a date of service that falls within 120 days prior to the date the application is received by the Program.

Program Timing: (11) Patients must enroll on or before December 31, 2018, to be eligible to receive benefits. (12) If you live in Massachusetts, the Program co-pay card expires on the earlier of: (i) the expiration date of the Program co-pay card (December 31, 2018): (ii) the date an AB rated generic equivalent becomes available; or (iii) June 30, 2019, absent a change in Massachusetts state law.

Additional Program Terms and Conditions: (13) Patients, pharmacists, and healthcare providers must not seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this Program. Patients must not seek reimbursement from any health savings, flexible spending, or other healthcare reimbursement accounts for the amount of assistance received from the Program. (14) Acceptance of this offer confirms that this offer is consistent with your insurance and that you will report the value of the co-pay assistance you receive as may be required by your insurance provider. (15) This offer is not valid with any other financial support program, Patient Assistance Program (PAP), discount, or incentive involving the prescribed Lilly Oncology medicine. (16) Only valid in the United States and Puerto Rico; this offer is void where restricted or prohibited by law. (17) The Program benefits are nontransferable. (18) This offer is not conditioned on any past, present, or future purchase, including additional doses. (19) The Program is not insurance. (20) Lilly USA, LLC reserves the right to terminate, rescind, revoke, or amend this offer at any time without notice.