The Mounjaro Patient Assistance Program: How It Works, Who Qualifies, and How to Apply

Key Takeaways

• The Mounjaro patient assistance program is administered by the Lilly Cares Foundation, a 501(c)(3) charitable program separate from Eli Lilly's commercial operations.
• Eligibility generally requires U.S. residency, no prescription drug insurance coverage for Mounjaro, and household income at or below 400% of the federal poverty level.
• Approved patients receive Mounjaro at no cost for up to 12 months, with annual reapplication required.
• The Mounjaro Savings Card is a separate program for commercially insured patients without coverage; it can reduce the cost to as low as $25 per month.
• Application requires a prescription, a completed Lilly Cares form signed by the patient and the prescriber, and proof of income.

Direct answer (40-60 words)

The Mounjaro patient assistance program is run by the Lilly Cares Foundation. Eligible patients are U.S. residents without prescription drug insurance for Mounjaro, with household income at or below 400% of the federal poverty level. Approved patients receive Mounjaro at no cost for up to 12 months, with annual reapplication required.

Table of contents

1. The 30-second answer
2. Lilly Cares Foundation: what it is and how it differs from the savings card
3. Who qualifies for the Mounjaro patient assistance program
4. The 2026 income limits explained
5. How to apply: step-by-step
6. What happens after you apply
7. The Mounjaro Savings Card: a separate program for insured patients
8. If you are denied: alternatives and appeals
9. Cost of Mounjaro without assistance
10. FAQ
11. Sources
12. Footer disclaimers

Lilly Cares Foundation: what it is and how it differs from the savings card

Eli Lilly and Company runs two distinct programs to make Mounjaro more affordable.

The Lilly Cares Foundation Patient Assistance Program is a charitable program for patients who cannot afford Mounjaro and have no prescription drug insurance covering it. The foundation is a 501(c)(3) nonprofit, legally separate from Lilly's commercial business, even though Lilly funds and supports it. Approved patients receive Mounjaro at no cost.

The Mounjaro Savings Card is a commercial copay assistance program for patients who have commercial (private) insurance but face high copays or whose insurance does not cover Mounjaro. It is not a charity program. Eligible patients can pay as little as $25 for a 1, 2, or 3 month supply.

The two programs serve different populations:

Program	For whom	Who pays	Typical patient cost
Lilly Cares Patient Assistance	Uninsured or Mounjaro not covered, low income	Lilly Cares Foundation	$0
Mounjaro Savings Card	Commercially insured, high out-of-pocket	Lilly commercial program	As low as $25 per fill

People with government insurance (Medicare, Medicaid, Tricare, VA) are typically excluded from the Mounjaro Savings Card by federal anti-kickback rules. They may still qualify for Lilly Cares if income criteria are met and Mounjaro is not covered by their plan.

Who qualifies for the Mounjaro patient assistance program

Lilly Cares eligibility criteria, as published on the foundation's patient materials:

• U.S. resident. Citizens and lawful residents qualify. Documentation of residency is requested.
• Prescribed Mounjaro by a U.S.-licensed healthcare provider. A prescription is required to apply.
• No prescription drug insurance coverage for Mounjaro. This includes patients who are uninsured, patients whose insurance excludes Mounjaro from formulary, and Medicare Part D patients during the coverage gap (less common since the 2025 Inflation Reduction Act changes).
• Household income at or below 400% of the federal poverty level. This is the key financial criterion. See the 2026 limits in the next section.

Patients who have insurance that covers Mounjaro, even partially, are typically not eligible for Lilly Cares. The program is designed for patients with no other path to affording the medication. If you have a high copay but coverage exists, the Mounjaro Savings Card or independent foundations are the better fit.

Approval is for up to 12 months at a time. Patients reapply annually if continued assistance is needed.

The 2026 income limits explained

The 400% of federal poverty level (FPL) threshold means roughly:

Household size	100% FPL (2026)	400% FPL (Lilly Cares cutoff)
1 person	$15,650	$62,600
2 people	$21,150	$84,600
3 people	$26,650	$106,600
4 people	$32,150	$128,600
5 people	$37,650	$150,600
6 people	$43,150	$172,600

The 2026 figures above are based on the federal poverty guidelines published annually by the U.S. Department of Health and Human Services. The 400% multiplier is the Lilly Cares cutoff specifically. Other patient assistance programs use different multipliers (200%, 300%, 500%), so cutoffs vary by program.

Household income for Lilly Cares purposes typically includes wages, self-employment income, retirement income, Social Security, and certain investment income. SNAP, housing assistance, and similar non-cash benefits are not counted. The application asks for documentation, usually the most recent IRS Form 1040 or W-2.

A family of 4 with combined income of $120,000 falls under the 400% FPL cap and would meet the income criterion. A single person with income above $62,600 would not.

Higher income patients without insurance coverage for Mounjaro are not necessarily without options. The Mounjaro Savings Card requires commercial insurance, but other paths (manufacturer cash price programs, copay foundations, or alternative therapies) may apply.

How to apply: step-by-step

The application process for the Lilly Cares Mounjaro patient assistance program:

Step 1: Confirm you have a Mounjaro prescription.

Lilly Cares requires an active prescription. If you are exploring whether Mounjaro is appropriate for you clinically, that conversation happens with your provider before you apply for assistance.

Step 2: Download or request the Lilly Cares enrollment form.

The current form is available on the Lilly Cares Foundation website (lillycares.com) or by phone request to the foundation. The form has separate sections for the patient and the prescriber.

Step 3: Patient section.

Fill out demographic information, contact details, residency status, and a household income disclosure. Sign and date.

Step 4: Income documentation.

Attach a copy of one of the following:

• Most recent IRS Form 1040 (federal tax return)
• Most recent W-2 forms for everyone in the household with income
• Recent Social Security or pension benefit statements
• A signed statement of zero income if applicable

The foundation accepts redacted Social Security numbers on tax documents.

Step 5: Prescriber section.

Take the form to your provider. The provider fills in the prescription details (medication, dose, quantity, refills) and signs. This signed form serves as both the application and the prescription for fulfillment.

Step 6: Submit the form.

Submission options:

• Fax to the number listed on the Lilly Cares form
• Mail to the Lilly Cares Foundation address listed on the form
• Some providers can submit electronically through the foundation's portal

Step 7: Wait for a decision.

The foundation typically reviews applications within 7 to 10 business days. Expect a written decision letter. Approved patients receive instructions for receiving the medication shipment.

Step 8: Receive medication.

Approved patients receive Mounjaro shipped to their home or to their provider's office, depending on the program's current logistics. Standard shipments cover 30 to 90 days at a time.

What happens after you apply

Three possible outcomes follow an application:

Approval. You receive a letter or notice confirming enrollment for up to 12 months. Medication shipments begin. You will need to reapply at the end of the 12-month period if continued assistance is needed. Renewal applications are simpler than initial ones and usually only require updated income documentation.

Request for more information. If income documentation is unclear or the form is incomplete, the foundation may request additional documents. Respond promptly to keep the application active.

Denial. If you do not meet eligibility criteria, you receive a denial letter explaining why. The most common reasons for denial:

• Household income exceeds 400% FPL
• Insurance coverage exists for Mounjaro
• Missing required documentation
• Application was not signed by the prescriber

A denial does not preclude future applications. If your circumstances change (loss of insurance, change in income), reapply.

The Mounjaro Savings Card: a separate program for insured patients

If you have commercial insurance and your insurance covers Mounjaro but with a high copay, the Mounjaro Savings Card is the right program. Key features:

• Eligibility: Commercially insured patients with type 2 diabetes (Mounjaro's FDA-approved indication). Patients on Medicare, Medicaid, Tricare, or VA coverage are excluded by anti-kickback rules.
• Cost reduction: As low as $25 for a 1, 2, or 3 month supply, with annual maximums.
• Application: Online enrollment at the Mounjaro savings card page, no income verification required.
• Combination rules: Cannot be combined with other discount programs.

A common point of confusion: the Mounjaro Savings Card is for diabetes patients. The companion product Zepbound (also tirzepatide, but FDA-approved for chronic weight management) has its own savings card with different terms. Patients prescribed Mounjaro off-label for weight loss may run into eligibility issues at the pharmacy.

For patients prescribed tirzepatide for weight loss specifically, the Zepbound Savings Card is usually the appropriate program. A pharmacist can confirm which card applies given the indication on the prescription.

For an in-depth treatment of cost paths, see the Mounjaro coupon overview and the Zepbound coupon guide.

If you are denied: alternatives and appeals

A denial from Lilly Cares is not the end of the cost conversation. Several alternatives exist.

Independent copay foundations. Organizations like NeedyMeds, RxAssist, the HealthWell Foundation, the Patient Access Network Foundation, and Good Days have programs that sometimes cover GLP-1 medications. Eligibility varies by program and disease state, and funding cycles open and close.

State pharmaceutical assistance programs. Some states (notably New Jersey, Pennsylvania, New York) run Senior Pharmacy Assistance Programs that may cover diabetes medications including Mounjaro for eligible older residents.

Manufacturer cash price programs. Lilly's commercial program offers Zepbound (the same molecule, different indication) at a $499 monthly cash price through the LillyDirect direct-to-consumer pharmacy. The cash price is not the same as the assistance program but can be more affordable than retail.

Switching to compounded tirzepatide. Compounded versions of tirzepatide are typically less expensive than brand Mounjaro or Zepbound, often $200 to $400 per month through telehealth platforms. The clinical considerations are different (compounded medications are not FDA-approved), and the conversation with your provider is appropriate before switching.

Alternative GLP-1 medications. If Mounjaro specifically is not affordable, alternatives like semaglutide (brand or compounded) may be a workable substitute. They are different molecules with different efficacy and side effect profiles, but for many patients either one delivers meaningful clinical benefit.

Appeals. If you believe the denial was based on incorrect information (e.g., the foundation misread your income documentation), you can submit an appeal in writing with corrected documentation. The foundation reviews appeals within 30 days.

Cost of Mounjaro without assistance

For context on what the assistance program saves:

• Retail cash price: $1,059.87 to $1,193.20 for a 28-day supply (4 weekly pens), depending on dose, per published Lilly list prices in 2026.
• With commercial insurance and Mounjaro Savings Card (eligible patients): As low as $25 per fill.
• With Lilly Cares approval: $0.
• Through LillyDirect cash price (Zepbound for weight management): $499 per month for vials, slightly higher for pens.

The retail-to-assistance gap is meaningful. A patient eligible for Lilly Cares saves roughly $13,000 per year compared to retail. A patient who switches from retail to the LillyDirect cash price saves roughly $7,000 per year. The Mounjaro Savings Card delivers similar savings for insured patients.

The cost picture has been shifting since the IRA Medicare Part D changes took effect in 2025, which capped Part D out-of-pocket spending at $2,000 per year for Medicare beneficiaries. This change does not affect Lilly Cares directly but reduces total out-of-pocket costs for Medicare patients with Mounjaro on formulary.

FAQ

What is the Mounjaro patient assistance program? A charitable program run by the Lilly Cares Foundation that provides Mounjaro at no cost to U.S. patients without prescription drug insurance for Mounjaro and with household income at or below 400% of the federal poverty level. Approval is for up to 12 months at a time.

How do I apply for Mounjaro patient assistance? Download the Lilly Cares enrollment form from lillycares.com, complete the patient section, attach income documentation (typically your most recent IRS Form 1040), have your provider complete the prescriber section, and submit by fax, mail, or electronic portal. Decisions typically come within 7 to 10 business days.

Who qualifies for the Lilly Cares program? U.S. residents with a Mounjaro prescription, no prescription drug insurance covering Mounjaro, and household income at or below 400% of the federal poverty level. The 400% FPL cutoff is roughly $62,600 for a single person and $128,600 for a family of four in 2026.

Is the Mounjaro Savings Card the same as patient assistance? No. The savings card is a copay assistance program for commercially insured patients. The Lilly Cares program is a charitable program for uninsured or no-coverage patients. They serve different populations and have different rules.

Can Medicare patients use Mounjaro patient assistance? Sometimes. Medicare patients are excluded from the commercial Mounjaro Savings Card by anti-kickback rules. They may still qualify for Lilly Cares if their plan does not cover Mounjaro and their income falls under 400% FPL.

How long does Lilly Cares enrollment last? Up to 12 months per approval. Patients reapply annually if continued assistance is needed. Renewal applications are simpler than initial ones.

What if I am denied for Mounjaro patient assistance? Consider independent copay foundations (NeedyMeds, RxAssist, HealthWell, PAN Foundation), state pharmaceutical assistance programs, manufacturer cash price programs (LillyDirect for Zepbound), or alternative therapies including compounded tirzepatide or semaglutide. You can also appeal a denial in writing with corrected documentation.

Does the program cover Mounjaro for weight loss? Lilly Cares covers Mounjaro as prescribed by the patient's provider. The clinical decision to prescribe Mounjaro for diabetes (its FDA-approved indication) versus off-label for weight loss rests with the provider. The savings card has stricter indication rules; the assistance program is more flexible.

Can I get Mounjaro patient assistance if I have a high-deductible plan? A high-deductible plan that covers Mounjaro is still insurance coverage for purposes of Lilly Cares eligibility. The assistance program is for patients with no coverage, not for patients with high cost-sharing. The Mounjaro Savings Card is the more relevant program for that scenario.

How much money will Mounjaro patient assistance save me? At retail cash price, Mounjaro runs roughly $1,060 to $1,200 per month. Lilly Cares approval reduces that to $0. Annual savings are approximately $13,000 for an approved patient using the medication continuously.

What income documents does Lilly Cares accept? Most recent IRS Form 1040, W-2 forms for household income earners, Social Security benefit statements, pension statements, or a signed statement of zero income. Redacted Social Security numbers on tax documents are accepted.

Is the program available to international residents? No. Lilly Cares is for U.S. residents only. International patients should check the manufacturer's regional patient assistance programs in their country, which operate separately.

Sources

1. Lilly Cares Foundation. Patient Assistance Program eligibility and enrollment materials. Accessed 2026.
2. U.S. Department of Health and Human Services. Federal Poverty Guidelines. 2026.
3. Eli Lilly and Company. Mounjaro Prescribing Information. Updated 2024.
4. U.S. Food and Drug Administration. Mounjaro (tirzepatide) approval letter and label. 2022.
5. Inflation Reduction Act of 2022, Public Law 117-169, Medicare Part D out-of-pocket cap provisions.
6. Centers for Medicare and Medicaid Services. Anti-kickback statute and prescription drug copay assistance guidance.
7. NeedyMeds. Patient assistance program directory. Accessed 2026.
8. Frias JP, et al. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes (SURPASS-2). N Engl J Med. 2021;385:503-515.

Footer disclaimers

Platform Disclaimer. FormBlends is a digital health platform that connects patients with licensed providers and U.S.-based pharmacies. We do not manufacture, prescribe, or dispense medication directly. All clinical decisions are made by independent licensed providers.

Compounded Medication Notice. Compounded semaglutide and tirzepatide are not FDA-approved. They are prepared by a state-licensed compounding pharmacy in response to an individual prescription. Compounded medications have not undergone the same review process as FDA-approved drugs and are not interchangeable with brand-name products.

Results Disclaimer. Individual results vary. Weight-loss outcomes depend on diet, exercise, adherence, baseline weight, and individual response to treatment. Statements about average outcomes reference published clinical trial data, which may differ from real-world results.

Trademark Notice. Mounjaro, Zepbound, and LillyDirect are registered trademarks of Eli Lilly and Company. FormBlends is not affiliated with, endorsed by, or sponsored by Eli Lilly or the Lilly Cares Foundation.