†Terms and Conditions
By enrolling in and using the Humatrope Savings Card Program (“Program”) and using the Humatrope Savings
Card (“Card”), you attest that you meet the eligibility criteria, and you agree to comply with the terms and
conditions described below:
Card Eligibility:
- You have been prescribed Humatrope for an approved use consistent with FDA approved product labeling;
- You are enrolled in a commercial drug insurance plan with coverage for Humatrope;
- You are not enrolled in any state, federal, or government funded healthcare program,
including, without limitation, Medicaid, Medicare, Medicare Part D, Medicare Advantage, Medigap,
DoD, VA, TRICARE®/CHAMPUS, or any state prescription drug assistance
program;
- You are a resident of the United States or Puerto Rico; and
- You are 18 years of age or older.
Card Terms and Conditions
For patients with commercial drug insurance coverage for Humatrope: You must have commercial drug insurance that
covers Humatrope and a prescription for an approved use consistent with FDA-approved product labeling to pay as
little as $0 for a 1-month prescription fill of Humatrope. Month is defined as 30-days. Card savings are subject to a
maximum monthly savings of wholesale acquisition cost plus usual and customary pharmacy charges and separate
maximum annual savings of up to $3,200 per calendar year. Card may be used for maximum of up to 12 prescription
fills per calendar year. Subject to Lilly USA, LLC’s (“Lilly”) right to terminate, rescind, revoke, or amend Card eligibility
criteria and/or Card terms and conditions which may occur at Lilly’s sole discretion, without notice, and for any reason.
Card expires and savings end on 12/31/2026.
Additional Program Terms and Conditions
If you have an insurance plan that is participating in an alternate funding program (“AFP”) that requires you to apply to
the Humatrope Savings Card Program or otherwise pursue specialty drug prescription coverage through an alternate
funding vendor as a condition of, requirement for, or prerequisite to coverage of Humatrope, you are not eligible for
and are prohibited from using the Humatrope Savings Card Program. AFPs include programs where coverage,
reimbursement, or patient out of pocket costs for a product in some way vary based on the availability of a
manufacturer co-pay program. AFPs may modify, delay, deny, restrict, or withhold insurance benefits or coverage from
patients, or exclude Lilly products from coverage contingent upon a member’s use of Humatrope Savings Card
Program. You agree to inform Humatrope Savings Card Program if you are or become a member of such an alternative
funding program. You are responsible for any applicable taxes, fees, and any amount that exceeds the monthly or
annual maximum Card savings. Monthly and annual maximum savings are set at Lilly’s sole and absolute discretion
and may be changed with or without notice at any time for any reason. At its sole discretion and with or without notice,
Lilly may reduce, eliminate, or otherwise modify the Card savings for any reason, including but not limited to if your
commercial drug insurance plan imposes additional requirements which limits or prevents you from receiving coverage
for Humatrope, only allows partial coverage for Humatrope, removes coverage for Humatrope and requires you to
utilize the Card, does not provide a material level of financial assistance for the cost of Humatrope, or does not apply
Card payments to satisfy your co-payment, deductible, or coinsurance for Humatrope. Card savings are not valid for:
Massachusetts residents if an AB-rated generic equivalent is available; California residents if an FDA-approved
therapeutic equivalent is available. You must meet the Card eligibility criteria, terms and conditions every time you
use the Card. If at any time you begin receiving drug coverage under any state, federal, or government funded healthcare
program, you understand that you will no longer be eligible for the Humatrope Savings Card and agree to call the
Humatrope Savings Card Program at 1-877-456-6837 to stop participation. Card activation is required. You may not
seek reimbursement from your health insurance, any third party, or any health savings, flexible spending, or other
healthcare reimbursement accounts, for any amount of the savings received through the Card. By utilizing the Card,
you agree that if you are required to do so under the terms of your insurance coverage for this prescription or are
otherwise required to do so by law, you will notify your Insurance Carrier of your redemption of the Card. Card savings
cannot be combined or utilized with any other program, discount, discount card, cash discount card, coupon, incentive,
or similar offer involving Humatrope. You agree that this Card savings is intended solely for the benefit of you, the
patient, and that the Card benefits are non-transferable. It is prohibited for any person to sell, purchase, or trade; or to
offer to sell, purchase, or trade, or to counterfeit the Card. THIS CARD IS NOT INSURANCE. Lilly has the sole right to
interpret and apply Card eligibility criteria, and terms and conditions. Card eligibility, and terms and conditions may be
terminated, rescinded, revoked, or amended by Lilly at any time without notice and for any reason. Lilly’s sole
discretion to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions includes the
right to terminate any individual Card if Lilly determines, in its sole discretion, that a patient does not satisfy the Card’s
eligibility criteria or is using or has attempted to use the Card inconsistently with these terms and conditions. Eligibility
criteria, and terms and conditions for the Humatrope Savings Card Program may change from time to time; the most
current version can be found at https://www.humatrope.lilly.com/patient-support. You may be required to obtain a
new Card, including if any Card terms and conditions have been terminated, rescinded, revoked, or amended by Lilly.
Card void where prohibited by law. Subject to Lilly’s right to terminate, rescind, revoke or amend Card eligibility criteria
and/or Card terms and conditions which may occur at Lilly’s sole discretion, without notice, and for any reason. Card
expires and savings end on 12/31/2026.
TRICARE® is a registered trademark of the Department of Defense (DoD), DHA.