You’re committed to managing your diabetes.

By using the Lilly Insulin Value Cash Savings Card Program (“Card”), you attest that you meet the eligibility criteria, and you agree to comply with the terms and conditions described below:

Card Eligibility:

Card Terms and Conditions
You must have a prescription consistent with FDA-approved product labeling to pay as little as $35 for a 1-month prescription fill of your Covered Insulin. Month is defined as 30-days. Card savings are subject to a maximum monthly savings of wholesale acquisition cost plus usual and customary pharmacy charges per prescription fill, up to a maximum of 14 prescription fills per calendar year for each Covered Insulin. Subject to Lilly USA, LLC’s (“Lilly”) right to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly’s sole discretion, without notice, and for any reason, Card expires and savings end on 12/31/2024.

Additional Program Terms and Conditions
If you have an insurance plan that is participating in an alternate funding program (“AFP”) (examples include, but are not limited to, ImpaxRX, Payer Matrix, SHARx, Script Sourcing, and Paydhealth) that requires you to apply to the Lilly Insulin Value Cash Savings Card Program or otherwise pursue specialty drug prescription coverage through an alternate funding vendor as a condition of, requirement for, or prerequisite to coverage of your Covered Insulin, you are not eligible for and are prohibited from using the Lilly Insulin Value Cash Savings Card Program. AFPs include programs where coverage, reimbursement, or patient out of pocket costs for a product in some way vary based on the availability of a manufacturer co-pay program. AFPs may modify, delay, deny, restrict, or withhold insurance benefits or coverage from patients, or exclude Lilly products from coverage contingent upon a member's use of Lilly Insulin Value Cash Savings Card Program. You agree to inform Lilly Insulin Value Cash Savings Card Program if you are or become a member of such an alternative funding program. You are responsible for any applicable taxes, fees, and any amount that exceeds the monthly or annual maximum Card savings. Monthly and annual maximum savings are set at Lilly's sole and absolute discretion and may be changed with or without notice at any time for any reason. At its sole discretion and with or without notice, Lilly may reduce, eliminate, or otherwise modify the Card savings for any reason including but not limited to if your commercial drug insurance plan imposes additional requirements which limits or prevents you from receiving coverage for your Covered Insulin, only allows partial coverage for your Covered Insulin, removes coverage for your Covered Insulin and requires you to utilize the Card, does not provide a material level of financial assistance for the cost of your Covered Insulin, or does not apply Card payments to satisfy your co-payment, deductible, or coinsurance for your Covered Insulin. Card savings are not valid for: Massachusetts residents if an AB-rated generic equivalent is available; California residents if an FDA-approved therapeutic equivalent is available. You must meet the Card eligibility criteria, terms and conditions every time you use the Card. Card activation is required. No party may seek reimbursement from your health insurance, any third party, or any health savings, flexible spending, or other healthcare reimbursement accounts, for any amount of the savings received through the Card. Card savings cannot be combined or utilized with any other program, discount, discount card, cash discount card, coupon, incentive, or similar offer involving your Covered Insulin. You agree that this Card savings is intended solely for the benefit of you, the patient, and that the Card benefits are nontransferable. It is prohibited for any person to sell, purchase, or trade; or to offer to sell, purchase, or trade, or to counterfeit the Card. The Card is not insurance. Lilly has the sole right to interpret and apply Card eligibility criteria, and terms and conditions. Card eligibility, and terms and conditions may be terminated, rescinded, revoked, or amended by Lilly at any time without notice and for any reason. Eligibility criteria, and terms and conditions for the Lilly Insulin Value Cash Savings Card Program may change from time to time; the most current version can be found at https://www.insulinaffordability.com. You may be required to obtain a new Card, including if any Card terms and conditions have been terminated, rescinded, revoked, or amended by Lilly. Card void where prohibited by law. Subject to Lilly’s right to terminate, rescind, revoke or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly’s sole discretion, without notice, and for any reason, the Card expires and savings end on 12/31/2024.

By using the Lilly Insulin Value Savings Card Program (“Card”), you attest that you meet the eligibility criteria, and you agree to comply with the terms and conditions described below:

Card Eligibility:

Card Terms and Conditions

For patients with commercial drug insurance coverage for your Covered Insulin: You must have commercial drug insurance that covers your Covered Insulin and a prescription consistent with FDA-approved product labeling to pay as little as $35 for a 1-month prescription fill of your Covered Insulin. Month is defined as 30-days. Card savings are subject to a maximum monthly savings of up to $3,000 per prescription fill of each Covered Insulin and separate maximum annual savings of up to $16,000 per calendar year for each Covered Insulin. Card may be used for a maximum of up to 16 prescription fills per calendar year for each Covered Insulin. Subject to Lilly USA, LLC’s (“Lilly”) right to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly’s sole discretion, without notice, and for any reason, Card expires and savings end on 12/31/2024.

For patients with commercial drug insurance who do not have coverage for your Covered Insulin: You must have commercial drug insurance that does not cover your Covered Insulin and a prescription consistent with FDA-approved product labeling to pay as little as $35 for a 1-month prescription fill of your Covered Insulin. Month is defined as 30-days. Card savings are subject to a maximum monthly savings of wholesale acquisition cost plus usual and customary pharmacy charges per prescription fill, up to a maximum of 14 prescription fills per calendar year for each Covered Insulin. Subject to Lilly’s right to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly’s sole discretion, without notice, and for any reason, Card expires and savings end on 12/31/2024.

Additional Program Terms and Conditions
If you have an insurance plan that is participating in an alternate funding program (“AFP”) (examples include, but are not limited to, ImpaxRX, Payer Matrix, SHARx, Script Sourcing, and Paydhealth) that requires you to apply to the Lilly Insulin Value Savings Card Program or otherwise pursue specialty drug prescription coverage through an alternate funding vendor as a condition of, requirement for, or prerequisite to coverage of your Covered Insulin, you are not eligible for and are prohibited from using the Lilly Insulin Value Savings Card Program. AFPs include programs where coverage, reimbursement, or patient out of pocket costs for a product in some way vary based on the availability of a manufacturer co-pay program. AFPs may modify, delay, deny, restrict, or withhold insurance benefits or coverage from patients, or exclude Lilly products from coverage contingent upon a member’s use of Lilly Insulin Value Savings Card Program. You agree to inform Lilly Insulin Value Savings Card Program if you are or become a member of such an alternative funding program. You are responsible for any applicable taxes, fees, and any amount that exceeds the monthly or annual maximum Card savings. Monthly and annual maximum savings are set at Lilly’s sole and absolute discretion and may be changed with or without notice at any time for any reason. At its sole discretion and with or without notice, Lilly may reduce, eliminate, or otherwise modify the Card savings for any reason, including but not limited to if your commercial drug insurance plan imposes additional requirements which limits or prevents you from receiving coverage for your Covered Insulin, only allows partial coverage for your Covered Insulin, removes coverage for your Covered Insulin and requires you to utilize the Card, does not provide a material level of financial assistance for the cost of your Covered Insulin, or does not apply Card payments to satisfy your co-payment, deductible, or coinsurance for your Covered Insulin. Card savings are not valid for: Massachusetts residents if an AB-rated generic equivalent is available; California residents if an FDA-approved therapeutic equivalent is available. You must meet the Card eligibility criteria, terms and conditions every time you use the Card. Card activation is required. No party may seek reimbursement from your health insurance, any third party, or any health savings, flexible spending, or other healthcare reimbursement accounts, for any amount of the savings received through the Card. By utilizing the Card, you agree that if you are required to do so under the terms of your insurance coverage for this prescription or are otherwise required to do so by law, you will notify your Insurance Carrier of your redemption of the Card. Card savings cannot be combined or utilized with any other program, discount, discount card, cash discount card, coupon, incentive, or similar offer involving your Covered Insulin. You agree that this Card savings is intended solely for the benefit of you, the patient, and that the Card benefits are nontransferable. It is prohibited for any person to sell, purchase, or trade; or to offer to sell, purchase, or trade, or to counterfeit the Card. The Card is not insurance. Lilly has the sole right to interpret and apply Card eligibility criteria, and terms and conditions. Card eligibility, and terms and conditions may be terminated, rescinded, revoked, or amended by Lilly at any time without notice and for any reason. Eligibility criteria, and terms and conditions for the Lilly Insulin Value Savings Card Program may change from time to time; the most current version can be found at https://www.insulinaffordability.com. You may be required to obtain a new Card, including if any Card terms and conditions have been terminated, rescinded, revoked, or amended by Lilly. Card void where prohibited by law. Subject to Lilly’s right to terminate, rescind, revoke or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly’s sole discretion, without notice, and for any reason, the Card expires and savings end on 12/31/2024.