Mounjaro (tirzepatide)

Do You Qualify?

Income Limits (400% FPL)

Income threshold calculated at 400% of the 2025 FPL. Eligibility is generally limited to those without insurance or with Medicare Part D who meet specific criteria.

Based on 2025 HHS Federal Poverty Level guidelines.

# Mounjaro (Tirzepatide) Patient Assistance Guide: Lilly Cares Foundation Program

Who Qualifies for the Lilly Cares Foundation Patient Assistance Program?

If you have been prescribed Mounjaro (tirzepatide) for type 2 diabetes and cannot afford it, you may be able to get it at no cost through the Lilly Cares Foundation Patient Assistance Program. This program is run by Eli Lilly, the maker of Mounjaro. To qualify, you generally need to earn $60,240 or less per year if you live alone — with higher limits for larger households. You must also meet specific insurance requirements: this program is designed for people who are uninsured or who have Medicare Part D. If you have private commercial insurance, you are typically not eligible for this patient assistance program, though a separate savings card option may be available to you.

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About Mounjaro (Tirzepatide)

Mounjaro (tirzepatide) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to help manage blood sugar levels in adults with type 2 diabetes mellitus. It belongs to a drug class called GIP and GLP-1 receptor agonists, which work by targeting two hormone receptors involved in blood sugar regulation. Without insurance or financial assistance, Mounjaro can cost over $1,000 per month out of pocket, placing it out of reach for many patients. No FDA-approved generic or biosimilar version of Mounjaro currently exists, which means the brand-name drug is the only option available — making patient assistance programs an important resource for those who qualify.

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Income Eligibility: Full Breakdown

The Lilly Cares Foundation uses income thresholds set at 400% of the 2025 Federal Poverty Level (FPL). The table below shows the maximum annual household income allowed based on household size:

| Household Size | Max Annual Income |

|---|---|

| 1 person | $60,240 |

| 2 persons | $81,760 |

| 3 persons | $103,280 |

| 4 persons | $124,800 |

Your income is typically verified using your most recent federal tax return, W-2 forms, or 1099 forms. If your income situation has changed recently, some programs accept three months of recent pay stubs as an alternative. Household size generally includes everyone living in your home who shares finances, such as a spouse or dependents.

If your income is above the limit for your household size, you may not qualify for the free medication program. However, you should still explore the options listed in the "Alternatives" section below — other forms of help may still be available to you. Income guidelines can also change year to year, so it is worth checking the current requirements directly with the program if you are close to the limit.

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Insurance Requirements Explained

Your insurance status plays a major role in whether you qualify. Here is how different situations are handled:

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Step-by-Step: How to Apply

Follow these steps to apply for the Lilly Cares Foundation Patient Assistance Program:

1. Confirm your eligibility. Review the income and insurance requirements above. If you are uninsured or have Medicare Part D and meet the income limits, proceed.

2. Gather your documents. You will need:

- Proof of income (most recent federal tax return, W-2, or 1099)

- A valid, current prescription for Mounjaro from your healthcare provider

- A completed application form with your healthcare provider's signature

3. Get the application form. Visit www.lillycares.com to access the online application or download a paper form. You can also call (800) 545-6962 to request a form by phone.

4. Complete the application. Fill out all required sections. Your prescribing doctor must also sign the form. Many providers are familiar with this process and can assist you.

5. Submit your application. You can apply online at www.lillycares.com, submit by fax to (844) 431-6650, or mail your completed form and documents per the instructions on the application.

6. Wait for a decision. Processing typically takes 7 to 10 business days after the program receives your complete application.

7. Receive your medication. If approved, Mounjaro will be shipped directly to your home address.

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What to Expect: Timeline and Delivery

After submitting a complete application, you can typically expect a decision within 7 to 10 business days. You will be notified of your approval status, and your medication will be shipped directly to you — you do not need to visit a pharmacy or your doctor's office to pick it up. Make sure your shipping address on the application is current and accurate.

This program requires annual reauthorization. That means once a year, you will need to reapply and confirm that you still meet the income and insurance eligibility requirements. You will need to submit updated income documentation at that time. Staying on top of this renewal helps prevent any interruption in your medication supply.

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Alternatives If You Don't Qualify

If you do not qualify for the Lilly Cares Foundation Patient Assistance Program, here are other options to explore:

1. Biosimilars: There are currently no FDA-approved biosimilar or generic versions of Mounjaro available. This option is not available at this time.

2. Mounjaro Savings Card (for insured patients): If you have commercial insurance, you may qualify for the Mounjaro savings card, which can reduce your out-of-pocket cost. Visit https://www.mounjaro.lilly.com/savings-resources to learn more and check eligibility.

3. State Pharmaceutical Assistance Programs (SPAPs): Many states offer their own drug assistance programs, particularly for Medicare beneficiaries. Eligibility and benefits vary by state. Your state's health department or aging services office can help you find programs in your area.

4. NeedyMeds.org: This free, nonprofit database at www.needymeds.org lists patient assistance programs, drug discount cards, and other cost-reduction resources. It is a useful starting point if you need to explore multiple options.

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*This guide is for informational purposes only and does not constitute medical or legal advice. Eligibility determinations are made solely by Eli Lilly. Program terms may change — verify current requirements at [https://www.mounjaro.com/savings-resources](https://www.mounjaro.com/savings-resources) before applying.*

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