yes, you have to reapply annually. They send a renewal packet about 30 days before your year is up. It's basically the same paperwork again with updated income verification. I've renewed once so far — went smoothly. One tip: keep copies of EVERYTHING you submit. I scan it all before mailing.

Just want to add — if you go the PAP route, be aware that Lilly Cares medications are specifically labeled "not for resale" and your pharmacy can't be involved. The medication ships directly from the program to your home (or sometimes doctor's office). Also, while you're waiting for approval, check if Lilly still has any savings card programs running. The landscape has changed a lot in 2025-2026, but sometimes there are bridge programs for the gap period. The Mounjaro savings card (when available) could bring copays down to $25/month for commercially insured patients — but it sounds like your insurance doesn't cover it at all, which complicates savings card eligibility.

I've done two internal appeals. Hadn't considered the external appeal route — I'll ask about that. The prediabetes angle is interesting too. My fasting glucose has been consistently 110-120 and my doctor has been watching it closely. yeah the savings card doesn't work because my insurance has a blanket exclusion. I looked into it already. 😞 Going to pursue both the external appeal AND the PAP application simultaneously. No reason I can't do both right?

Absolutely do both simultaneously. There's no rule against it. If the insurance appeal comes through first, great — you'll have more sustainable long-term coverage. If the PAP comes through first, you're covered while you continue fighting insurance. Pro tip for the PAP application: have your doctor write a detailed letter of medical necessity to include with the application. Even though it's not technically required, I've found applications with a doctor's letter explaining the clinical rationale get processed faster and have higher approval rates. Include: your BMI history, comorbidities (prediabetes, any others?), failed interventions, and why tirzepatide specifically is needed vs. alternatives.

Update for anyone following this thread: I submitted both the external appeal and the Lilly Cares application last week. Will report back on timelines and outcomes. Thanks everyone for the guidance — this community is amazing. 🙏