The Lilly Cares application form asks for the number of people and the yearly total gross income of the household, according to the Partnership for Prescription Assistance. It also asks for basic contact information and the applicant's date of the birth. In addition to filling out the application for, the program requires applicants to provide proof of income and proof of the amount of money spent on prescription medications for the current year.
To qualify for the Lilly Cares program, the applicant must be a resident of the United States and not eligible for Veteran's Administration benefits or Medicaid coverage, notes the Partnership for Prescription Assistance. The applicant must also have no prescription insurance or, if he has Medicare Part D insurance, he must spend at least $1,100 on prescription medication for the current year prior to applying.
The applicant's household must also make less than 300 percent of the federal poverty guidelines for Group A medications or 500 percent of the poverty guidelines for Group B medications, states the Lilly Cares application. For a two-person household, the limits are $47,790 and $79,650.
The applicant's doctor must also complete a section of the application, sign a confirmation statement and include a prescription for the medication covered under the program, notes the official Lily Cares application. Applicants with Medicare Part D coverage must also include a copy of the front and back of their insurance card.