Ebglyss Savings Card - Non-covered benefit

Funded

About

The Ebglyss Savings Card - Non-covered benefit program is designed to help patients manage the cost of their Ebglyss prescriptions. By participating in the Ebglyss Savings Card program, eligible patients can pay as little as $25 per monthly prescription fill if their insurance does not cover Ebglyss, making it significantly more affordable. This program is geared towards patients with private insurance and provides substantial savings on Ebglyss, a critical drug product for eligible individuals.

Insurance requirements: Commercially insured, Underinsured

As low as: $25 per mo

Enrollment Forms

Enrollment Form

Benefits

•24 maximum fills per year

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: Yes

Program Details

•If Ebglyss is not covered by commercial insurance, patients may be eligible to pay as little as $25 for each monthly prescription fill

•Participation in the $25 Program requires submission of a prior authorization (PA) and a coverage denial outcome prior to first prescription fill

•For patients who enrolled in the $25 Program on or before May 31, 2025, to remain eligible for continued enrollment in the $25 Program, a new PA must be submitted with a denial outcome received by August 1, 2025, and by each August 1st thereafter and as required by Lilly

•Card savings are subject to a maximum monthly savings of wholesale acquisition cost plus usual and customary pharmacy charges

•Card may be used for a maximum of up to 14 prescription fills per calendar year and a separate maximum of up to 24 prescription fills over the lifetime of the Program

Enrollment Forms

Enrollment Form