Forteo Patient Assistance
Lilly USA, LLC
The Forteo patient assistance program provides assistance to eligible patients, who are not also eligible for Medicare, and prescribed FORTEO® (teriparatide [rDNA origin] injection).
Contact Information
Forteo Connect
1-(866) 436-7836 (phone)
1-866-4FORTEO (vanity_phone)
Forteo Connect
1-(866) 436-7836 (phone)
1-866-4FORTEO (vanity_phone)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Eligibility:
This program is intended as temporary assistance for qualifying patients who do not have prescription drug insurance. Processing a completed application and arranging for product shipment will take approximately 4 weeks. Product will be shipped directly to the patient by the program pharmacy. General eligibility requirements for the new program are: - Not eligible for Medicare - No prescription-drug insurance or coverage (including Medicaid, VA, private insurance, etc.) - Income must be within specified limits - Must be a US resident Additional eligibility requirements may also apply. Blank applications can be printed from www.forteo.com or requested by calling 866-436-7836 (866-4FORTEO). If accepted into the program, a patient will receive a letter that includes a membership card and information on how to contact the program pharmacy that will provide the product. Patient enrollment is for a one year period, at which time the patient may reapply for a second year enrollment. For more information, please call 866-436-7836 (866-4FORTEO). Please see Black Box Warning and Important Safety Information for Forteo.
This program is intended as temporary assistance for qualifying patients who do not have prescription drug insurance. Processing a completed application and arranging for product shipment will take approximately 4 weeks. Product will be shipped directly to the patient by the program pharmacy. General eligibility requirements for the new program are: - Not eligible for Medicare - No prescription-drug insurance or coverage (including Medicaid, VA, private insurance, etc.) - Income must be within specified limits - Must be a US resident Additional eligibility requirements may also apply. Blank applications can be printed from www.forteo.com or requested by calling 866-436-7836 (866-4FORTEO). If accepted into the program, a patient will receive a letter that includes a membership card and information on how to contact the program pharmacy that will provide the product. Patient enrollment is for a one year period, at which time the patient may reapply for a second year enrollment. For more information, please call 866-436-7836 (866-4FORTEO). Please see Black Box Warning and Important Safety Information for Forteo.
Other Information:
24 months maximum FORTEO therapy supplied in this program.
24 months maximum FORTEO therapy supplied in this program.
Product(s) covered by program:
- FORTEO®
