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| Program Contact Info / Application Submission |
| Program | Access for Humatrope | | Company | Eli Lilly & Company | | Form | Download PDF | | Address | Humatrope Reimbursement Center
100 Grandview Rd., Suite 210
Braintree, MA 02184 | | Phone | 800-642-2340 | | Fax | 317-779-0961 | | Website | http://www.humatrope.com/common_pages/hcp_reimbursement.jsp?reqNavId=3.3.3 | | |
| Program Details |
| Details | Up to a 90-day supply will be sent to the patient�s home. The company will contact the patient to arrange for refills. The company will contact the patient regarding reapplication.
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| Program Requirements |
| Information | A portion of the form must be filled out and signed by the doctor. The company will contact the patient for the needed information and documentation. | | |
| Eligibility |
| Eligibility | Patient must be under treatment by a US doctor and meet income guidelines that are not disclosed. This program provides medication with a co-pay or free of charge, as determined by consideration of patient/household income. | | |
| Other Medications |
Other
Medications
available in
this program | |
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