I help patients navigate PAP applications regularly. Here's what I know about Lilly Cares as of early 2026: Eligibility basics: - Must be a US resident - Must not have prescription drug coverage that covers the medication (denied counts!) - Income guidelines are generally at or below 400% of the Federal Poverty Level - For a family of 4 in 2026, 400% FPL is approximately $130,000 At $52k you should be well within the income limits. The tricky part is the diagnosis — Mounjaro's PAP has historically been more straightforward for T2D patients. For weight management (even with prediabetes), it can be harder. Your prediabetes diagnosis actually helps your case significantly. Make sure your doctor codes it appropriately.

I was approved! 🙌 Family of 3, income around $61k. Here's my experience: Timeline: - Submitted application: took about 2 weeks to gather everything - Received confirmation of receipt: 3 business days after mailing - Approval notification: about 4 weeks after submission - First shipment: 1 week after approval I have T2D so my situation might be different from yours, but the process itself was straightforward. They send 90-day supplies directly to your door. Completely free. The paperwork needed: 1. anders_CPH application form (from lillycares.com) 2. Prescriber form (your doctor fills this out) 3. Proof of income (recent tax return or pay stubs) 4. Copy of insurance denial letter

that income limit is way higher than I expected. I was assuming it would be like $30-40k max. That's a relief. thank you for the timeline breakdown! Did you have to reapply every year?

before you go the PAP route (which is great as a backup), have you tried these steps with your insurance? 1. External appeal — if you've only done internal appeals, you have the right to an external review by an independent third party. This is required under the ACA. 2. Step therapy exception — if they want you to try other things first, your doctor can request a step therapy exception based on medical necessity. 3. Prediabetes angle — have your doctor reclassify the prescription purpose. Mounjaro is FDA-approved for T2D, and A1c of 6.1 with other risk factors might warrant a T2D prevention argument. I got my initial denial overturned on external appeal. It took persistence but saved me from having to rely on a PAP long-term.