Emgality Patient Savings Program

Emgality Savings Card

Offer good for up to 12 months until 12/31/2020 if healthcare provider submits a prior authorization form or coverage exception request, when required, to the patient’s insurance provider. $0 monthly offer for commercially insured with insurance provider coverage, subject to wholesale acquisition cost plus usual and customary pharmacy charges and a separate $4900 maximum annual cap. $0 monthly offer for commercially insured without insurance provider coverage, subject to monthly and annual cap of wholesale acquisition cost plus usual and customary pharmacy charges.

Terms and Conditions:

This offer is not available for patients without commercial drug insurance or those whose prescription claims are eligible to be reimbursed, in whole or in part, by Medicare Part D, Medicaid, TRICARE or any other state or federal program

Medicare/Medicaid – Lilly Cares Foundation Assistance program can be utilized for non-covered situations such as patients whose primary insurance is non-commercial. Lilly Cares Foundation will conduct their own benefits review and contact the patient about how much coverage they will be able to offer through their disease state fund.