Lilly Minnesota Insulin State Patient Assistance Program™
Pursuant to Minnesota law, a Minnesota resident is eligible to receive a 30-day urgent-need supply of insulin if an individual completes an application (accessible through the MNsure website), which requires the individual to attest to:
• being a resident of Minnesota
• not being enrolled in medical assistance or MinnesotaCare
• not being enrolled in prescription drug coverage that limits the total amount of cost-sharing that the enrollee is required to pay for a 30-day supply of insulin, including co-payments, deductibles, or coinsurance, to $75 or less, regardless of the type or amount of insulin prescribed
• not having received an urgent-need supply of insulin through this program within the previous 12 months
• being in urgent need of insulin ("urgent need of insulin" means having readily available for use less than a seven-day supply of insulin and in need of insulin in order to avoid the likelihood of suffering significant health consequences)
The individual must bring a completed, signed and dated application to a pharmacy. The individual must also provide a valid insulin prescription and valid identification to the pharmacy.
Learn more on the Minnesota Board of Pharmacy's Insulin Safety Net Program page.
If you are a pharmacist in the State of Minnesota dispensing Urgent Needs product for MNHF3100, visit www.voucheraccess.com.
• being a resident of Minnesota
• not being enrolled in medical assistance or MinnesotaCare
• not being enrolled in prescription drug coverage that limits the total amount of cost-sharing that the enrollee is required to pay for a 30-day supply of insulin, including co-payments, deductibles, or coinsurance, to $75 or less, regardless of the type or amount of insulin prescribed
• not having received an urgent-need supply of insulin through this program within the previous 12 months
• being in urgent need of insulin ("urgent need of insulin" means having readily available for use less than a seven-day supply of insulin and in need of insulin in order to avoid the likelihood of suffering significant health consequences)
The individual must bring a completed, signed and dated application to a pharmacy. The individual must also provide a valid insulin prescription and valid identification to the pharmacy.
Learn more on the Minnesota Board of Pharmacy's Insulin Safety Net Program page.
If you are a pharmacist in the State of Minnesota dispensing Urgent Needs product for MNHF3100, visit www.voucheraccess.com.
The Lilly Minnesota Insulin State Patient Assistance Program™ (“Program”) provides insulin to qualifying individuals for 12 months during the Patient’s enrollment in the Program. There are two options for a Patient to receive medication through the Program. For commercially insured Patients, Lilly may provide qualified individuals with a Savings Card. For all other qualified individuals, the individual’s pharmacy must order insulin from the Program through www.voucheraccess.com. Insulin is shipped to the enrolled individual’s pharmacy upon receipt of the order. The pharmacy will dispense the insulin directly to the Patient or parent/legal guardian of a Minor Patient. In both cases, the pharmacy may charge up to a $50 copay for a 90-day supply of the insulin.
The individual must bring their Statement of Eligibility letter provided by Lilly to their pharmacy. The individual must also provide a valid insulin prescription and valid identification indicating residency in the form of a valid Minnesota identification card, driver’s license or permit, or a tribal identification card to the pharmacy.
Pursuant to Minnesota law, to be eligible to participate in the Lilly Minnesota Insulin State Patient Assistance Program™, the individual must:
• be a Minnesota resident with proof of Minnesota residency in the form of a valid Minnesota issued state identification card or driver's license or permit, or tribal identification card. If the individual is under the age of 18, the individual's parent or legal guardian must provide proof of residency
• have a family income that is equal to or less than 400% of the federal poverty guidelines
• not be enrolled in medical assistance or MinnesotaCare
• not be eligible to receive health care through a federally-funded program or receive prescription drug benefits through the U.S. Department of Veterans Affairs (Note: Medicare Part D enrollees are eligible if they have spent $1,000 on prescription drug coverage and meet the first three eligibility requirements above.)
• not be enrolled in prescription drug coverage through an individual or group health plan that limits the total amount of cost-sharing that an enrollee is required to pay for a 30-day supply of insulin, including co-payments, deductibles, or coinsurance to $75 or less, regardless of the type or amount of insulin needed
For those interested in learning more about this program, please contact the Lilly Minnesota Insulin State Patient Assistance Program™ at 1-855-447-8412 or learn more on the Minnesota Board of Pharmacy's Insulin Safety Net Program page.
To apply, please complete and submit the:
The individual must bring their Statement of Eligibility letter provided by Lilly to their pharmacy. The individual must also provide a valid insulin prescription and valid identification indicating residency in the form of a valid Minnesota identification card, driver’s license or permit, or a tribal identification card to the pharmacy.
Pursuant to Minnesota law, to be eligible to participate in the Lilly Minnesota Insulin State Patient Assistance Program™, the individual must:
• be a Minnesota resident with proof of Minnesota residency in the form of a valid Minnesota issued state identification card or driver's license or permit, or tribal identification card. If the individual is under the age of 18, the individual's parent or legal guardian must provide proof of residency
• have a family income that is equal to or less than 400% of the federal poverty guidelines
• not be enrolled in medical assistance or MinnesotaCare
• not be eligible to receive health care through a federally-funded program or receive prescription drug benefits through the U.S. Department of Veterans Affairs (Note: Medicare Part D enrollees are eligible if they have spent $1,000 on prescription drug coverage and meet the first three eligibility requirements above.)
• not be enrolled in prescription drug coverage through an individual or group health plan that limits the total amount of cost-sharing that an enrollee is required to pay for a 30-day supply of insulin, including co-payments, deductibles, or coinsurance to $75 or less, regardless of the type or amount of insulin needed
For those interested in learning more about this program, please contact the Lilly Minnesota Insulin State Patient Assistance Program™ at 1-855-447-8412 or learn more on the Minnesota Board of Pharmacy's Insulin Safety Net Program page.
To apply, please complete and submit the: