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Diabetes & Blood Sugar

Lyumjev Assistance Programs & Grants in Utah

Assistance information last verified: August 2026

Yes, and this is the clearest of the five insulin programs on this site. Lilly Cares states plainly that Group 2 medications — which include Lyumjev — are "For patients who have no insurance or have Medicare Part D" with income at or below 400% of the federal poverty level, and it publishes the actual dollar figures. The one bar is full Extra Help. Both diabetes charitable funds were closed. Financial assistance may be available through charitable foundations, manufacturer programs, Medicare's Extra Help program, or other assistance resources. Availability and eligibility change frequently — the information on this page was verified in August 2026.

How to Apply for Lyumjev Assistance Why Lilly Cares names Medicare Part D as a qualifying route, the difference between full and partial Extra Help for this application, and why insulin lispro-aabc is not the same as insulin lispro.

Can I get help paying for Lyumjev?

Yes, and this is the clearest of the five insulin programs on this site. Lilly Cares states plainly that Group 2 medications — which include Lyumjev — are "For patients who have no insurance or have Medicare Part D" with income at or below 400% of the federal poverty level, and it publishes the actual dollar figures. The one bar is full Extra Help. Both diabetes charitable funds were closed.

  • Lilly Cares Foundation: Lyumjev is on the available-medications list as a Group 2 medication — "For patients who have no insurance or have Medicare Part D and have a household annual adjusted gross income ≤ 400% FPL".
  • Published dollar limits, not a pointer elsewhere: $63,840 for one person, $86,560 for two, $109,280 for three, $132,000 for four, $154,720 for five, $177,440 for six.
  • Free medicine for up to 12 months, with annual reapplication. Lilly Cares charges no fee for enrollment, refills or participation.
  • The exclusion: "You are not enrolled in Medicaid, full Low Income Subsidy (LIS, 'Extra Help') or Veterans (VA) Benefits." Note "full" — Lilly's bar is narrower than Novo Nordisk's.
  • Lilly Insulin Value Program ($35/month): covers Lyumjev but excludes Medicare entirely. Lilly says so directly — "Government restrictions exclude people enrolled in federal government insurance programs from Lilly's $35 solutions." The card also expires 12/31/2026.
  • Charitable grants: TotalAssist lists all four Lyumjev presentations on its Type 2 diabetes funds — both closed ($1,500 guaranteed / $2,000 maximum). HealthWell's Type 2 Diabetes fund was closed. Good Days has no diabetes fund.

2 of the 5 programs we checked for Lyumjev were accepting applications when verified in August 2026.

About Lyumjev (insulin lispro-aabc)

Lyumjev is Eli Lilly's ultra-rapid mealtime insulin — insulin lispro reformulated to start working faster, which is what the "-aabc" suffix in its name signifies. That suffix matters practically: several plain insulin lispro products are on the market, including an unbranded one from Lilly itself, but they are different products rather than interchangeable versions of Lyumjev.

Approved uses

  • Improving blood sugar control in adults and children with type 1 or type 2 diabetes, taken around mealtimes

Manufacturer: Eli Lilly and Company

Why Lyumjev can be expensive on Medicare

Mealtime insulin is used several times a day for life. What sets Lyumjev apart on cost is not the price but the clarity of the help: the Lilly Cares Foundation publishes an explicit dollar income table and states in so many words that Medicare Part D enrollees may apply — which neither Sanofi nor Novo Nordisk does for their insulins. Lilly's $35 card, by contrast, excludes Medicare entirely.

Medicare coverage context

Lyumjev is covered under Medicare Part D or a Medicare Advantage drug plan, and under federal law a covered insulin costs no more than $35 for a month's supply with no deductible applied; our <a href="/insulin-cost-medicare-vernal.html">insulin cost guide</a> covers how that works across products. Lyumjev is not a Medicare-negotiated drug — CMS's selected-drug file has no Lyumjev or insulin lispro row for 2026, 2027 or 2028, and the only insulin ever selected is Novo Nordisk's insulin aspart. Part D out-of-pocket costs are capped at $2,100 in 2026. Worth noting for anyone comparing insulins: Lyumjev comes in U-100 and U-200 KwikPens and a Junior KwikPen, and these are separate formulary entries, so check the tier for the exact presentation you are prescribed.

Lyumjev assistance options at a glance

Every program we checked, what kind of help it is, whether people with Medicare can use it, and its status when we verified it. A medication being listed by a program is not the same as the program accepting applications.

About the income limits below: Income limits can differ between assistance programs even when both describe their eligibility as the same percentage of the federal poverty level. The dollar limits shown here come from each program's own published income table, and each program decides which year's poverty guidelines that table is built from and when it takes effect. Treat the figures as belonging to the program they are listed under — they are not interchangeable, and only the program can tell you which table it is applying to your application today.

Lyumjev assistance programs compared
ProgramType of helpPeople with MedicareStatus (August 2026)
Lilly Cares Foundation Patient Assistance Program Manufacturer patient assistance may apply Accepting applications
Lilly Insulin Value Program Commercial copay / savings card not eligible Open with limits
TotalAssist — Type 2 diabetes funds Charitable grant may apply Closed to new applicants
HealthWell Foundation — Type 2 Diabetes fund Charitable grant may apply Closed to new applicants
Good Days — no applicable fund Charitable grant not stated No program found
Medicare Extra Help (Part D Low-Income Subsidy) Government program may apply Accepting applications

Manufacturer programs from Eli Lilly and Company

A patient assistance program (free or low-cost drug by income) is not the same as a copay card (a commercial discount that usually excludes Medicare). Both are listed so you can see which one applies to you.

Manufacturer patient assistance

Lilly Cares Foundation Patient Assistance Program

Lilly Cares Foundation, Inc., a nonprofit charitable organization

Accepting applications Medicare: may apply

Status: Accepting applications on August 26, 2026. Lyumjev appears on the foundation's available-medications list and is classified as a Group 2 medication, which is what sets its income limit and its insurance rules.

A nonprofit foundation that has supplied Lilly medicines free for over twenty years, covering Lyumjev for up to 12 months at a time. Of the five insulin manufacturer programs on this site, it is the one whose rules you can read and apply to your own situation without a phone call.

If you have Medicare: This is the most explicit Medicare statement of any insulin program on this site. Lilly Cares defines Group 2 Medications — the group Lyumjev belongs to — as being "For patients who have no insurance or have Medicare Part D and have a household annual adjusted gross income ≤ 400% FPL". Having Medicare Part D is a qualifying route, stated in those words, not an inference. The exclusion to watch is narrower than it first appears: "You are not enrolled in Medicaid, full Low Income Subsidy (LIS, 'Extra Help') or Veterans (VA) Benefits." Lilly bars full Extra Help specifically, where Novo Nordisk bars anyone who is enrolled in OR qualifies for it — so a partial-subsidy situation may play out differently between the two companies. Lilly also excludes patients whose employer or plan requires them to apply to a manufacturer program as a condition of coverage, which it calls an alternative funding program.

What it can cover: Lyumjev free of charge for up to 12 months to qualifying patients, with annual reapplication.

Who may qualify

  • Permanent resident of the United States, including Puerto Rico and the U.S. Virgin Islands
  • Your healthcare provider has prescribed a medication offered through Lilly Cares
  • No insurance OR Medicare Part D coverage (Lyumjev is a Group 2 medication)
  • Household annual adjusted gross income at or below 400% of the federal poverty level
  • Group 2 income limits: $63,840 for one person, $86,560 for two, $109,280 for three, $132,000 for four, $154,720 for five, $177,440 for six
  • Not enrolled in Medicaid, full Low Income Subsidy (Extra Help) or VA benefits
  • Not subject to an insurance plan or third party that requires you to apply to Lilly Cares as a condition of coverage

What the application asks for

  • Household size and total annual adjusted gross income before taxes, with proof
  • Your insurance details, including Medicare Part D coverage if you have it
  • Your prescriber's details — the application has a provider section

How to apply

Apply online, or download and print the application (English or Spanish) from lillycares.com, or call 1-800-545-6962 to have one mailed. Completed forms can be faxed to 1-844-431-6650 or posted to PO Box 501847, San Diego, CA 92150. Lilly Cares charges no fee for enrollment, refills or participation — and warns that third parties charging for that help are not affiliated with it.

Commercial copay / savings card

Lilly Insulin Value Program

Eli Lilly and Company

Open with limits Medicare: not eligible

Status: Active on August 26, 2026 at $35 per month for covered insulins including Lyumjev, but with a stated end date: "Card expires and savings end on 12/31/2026."

A $35-a-month program for people with commercial insurance or none, covering Lyumjev among other Lilly insulins. Closed to anyone on Medicare — and for a Medicare reader that costs nothing, because your plan's insulin cost-sharing reaches the same $35 anyway.

If you have Medicare: Lilly's terms exclude government coverage comprehensively: "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." Lilly states the position itself rather than burying it — "Government restrictions exclude people enrolled in federal government insurance programs from Lilly's $35 solutions" — and points Medicare beneficiaries to the fact that federal law already caps a covered insulin at $35 a month under a Medicare drug plan. That is accurate: for a Medicare reader the plan route reaches the same figure, and unlike this card it counts toward your out-of-pocket cap.

What it can cover: Lyumjev and other covered Lilly insulins at $35 per month for eligible patients. Not applicable to Medicare cost-sharing.

Who may qualify

  • Not enrolled in any state, federal or government-funded healthcare program, including Medicare, Medicare Part D, Medicare Advantage, Medigap, Medicaid, DoD, VA or TRICARE
  • Card expires and savings end on 12/31/2026

How to apply

Commercially insured and uninsured patients enrol through the Lilly insulin affordability pages. Medicare beneficiaries should use their plan's insulin cost-sharing and apply to Lilly Cares instead.

Charitable grants for Lyumjev

TotalAssist lists every Lyumjev presentation on its Type 2 diabetes fund and the health-equity version, each paying $1,500 guaranteed up to $2,000, and both were closed on August 26, 2026. HealthWell's Type 2 Diabetes fund was closed too, and Good Days runs no diabetes fund. As with every insulin on this site these are type 2 funds only, which leaves people taking Lyumjev for type 1 diabetes without a charitable route on these three foundations. That matters less here than it might elsewhere, because Lyumjev has the most reachable manufacturer program of the five insulins: Lilly Cares names Medicare Part D as a qualifying route and publishes its dollar limits, so you can settle your eligibility from the page rather than by waiting for a fund to reopen.

Charitable grant

TotalAssist — Type 2 diabetes funds

Patient Advocate Foundation · Type 2 diabetes (T2DM) · Type 2 diabetes health equity

Closed to new applicants Medicare: may apply

Status: Both funds were closed to new applicants on August 26, 2026, each with a $1,500 guaranteed and $2,000 maximum award.

All four Lyumjev presentations are named on the Type 2 diabetes approved-medication list — the base product, the KwikPen U-100 and U-200, and the Tempo Pen U-100 — so a change of pen would not cost you fund eligibility. Both funds were closed, and both are type 2 funds only.

If you have Medicare: These funds require government-insured coverage — Medicare, Medicaid or TRICARE — that covers your qualifying expenses. They do not exclude Extra Help enrollees, so if full Extra Help has closed the Lilly Cares door to you, these funds remain open in principle.

What it can cover: When open: $1,500 guaranteed award and up to $2,000 maximum for medication copays, coinsurance, deductibles and health-insurance premiums. One grant per condition.

Who may qualify

  • Confirmed type 2 diabetes diagnosis, in treatment, starting within 60 days, or treated in the past 6 months
  • Government-insured coverage (Medicare, Medicaid or TRICARE) that covers your qualifying expenses
  • Household income at or below 500% of the federal poverty level, adjusted for your regional cost-of-living index
  • Confirmed diagnosis matching the fund, and in treatment (or starting within 60 days, or treated in the past 6 months)
  • Legal U.S. resident receiving treatment in the U.S. or a U.S. territory
  • The health-equity fund additionally requires a home zip code in a designated social-vulnerability county

What the application asks for

  • Contact information and Social Security number (or alien number)
  • Annual household income (for pre-screening; proof of income due within 30 days of approval)
  • Health insurance carrier, plan type, policy ID and group number; Medicare supplement or secondary insurance if you have one
  • Copay or coinsurance amounts
  • Your provider's name and contact information, diagnosis (exact date if within 6 months), prescribed medications and treatment plan

How to apply

Sign up for fund notifications (text, email or automated call) at totalassist.org/notify. When a fund opens: You (the patient) apply online — it takes about 15 minutes and you learn immediately whether you are approved — or call 866-512-3861, Monday–Friday 8:30am–5:30pm ET. Patient Advocate Foundation verifies your diagnosis and treatment plan directly with your provider and verifies income automatically; you have 30 days after approval to provide proof of income.

Charitable grant

HealthWell Foundation — Type 2 Diabetes fund

HealthWell Foundation · Type 2 Diabetes

Closed to new applicants Medicare: may apply

Status: Closed on August 26, 2026. HealthWell runs no Type 1 Diabetes fund and no insulin-specific fund.

One applicable fund, closed. Lyumjev is a mealtime insulin used widely in type 1 diabetes, and none of the three foundations on this page runs a type 1 fund.

If you have Medicare: HealthWell accepts Medicare beneficiaries for the diseases it covers. Its Type 2 Diabetes fund was closed when we checked.

What it can cover: When open: copays, coinsurance, deductibles and health-insurance premiums for type 2 diabetes.

Who may qualify

  • A confirmed type 2 diabetes diagnosis, verified by your prescriber
  • Some form of health insurance (Medicare qualifies) that covers part of the cost of the drug — discount cards do not count
  • Social Security number (used to prevent duplicate applications)
  • Diagnosis verified by a physician's, nurse practitioner's or physician assistant's signature
  • Treatment in the United States

What the application asks for

  • Some form of health insurance (Medicare qualifies) that covers part of the cost of the drug — discount cards do not count
  • Social Security number (used to prevent duplicate applications)
  • Diagnosis verified by a physician's, nurse practitioner's or physician assistant's signature
  • Treatment in the United States

How to apply

When a fund is open, apply online or by phone; your provider verifies the diagnosis by signature. When a fund is closed, sign up for that fund's real-time alerts — HealthWell says replenished funds reopen "as quickly as possible."

Charitable grant

Good Days — no applicable fund

Good Days

No program found Medicare: not stated

Status: Good Days' published disease list on August 26, 2026 contained 57 programs and none of them was diabetes.

An honest negative, checked so you do not spend time on a third foundation that has no fund for you.

If you have Medicare: Good Days accepts Medicare beneficiaries for the diseases it covers, but it covers no diagnosis that applies to Lyumjev.

How to apply

Not applicable today. The diseases-covered page shows every fund Good Days runs.

How to apply for Lyumjev assistance

The written steps are complete on their own; the video above will walk through the same process when it is published.

  1. Step 1 — Find the applicable assistance program

    For Lyumjev on Medicare in August 2026, you can settle most of this from published rules rather than by phone:

    • Income at or below $63,840 for one person and not on full Extra Help → apply to Lilly Cares. Medicare Part D is explicitly a qualifying route.
    • On full Extra Help → use it; Lilly Cares is closed to you, but a covered insulin is capped at $35 a month under your plan anyway.
    • On partial Extra Help → call Lilly Cares on 1-800-545-6962 and ask, because their exclusion names full LIS specifically.
    • Check your plan's cost-sharing for your exact presentation — the KwikPen U-100, KwikPen U-200 and Junior KwikPen are separate formulary entries.
    • Type 2 diabetes → set alerts on the TotalAssist and HealthWell diabetes funds (all closed when checked).
    • Do not spend time on the Lilly Insulin Value Program if you have Medicare — it excludes you by name.
  2. Step 2 — Check whether applications are currently open

    The manufacturer program was open; the charitable funds were closed; the $35 card has an expiry date.

    • Lilly Cares: open, with the available-medications list and the medication groups published on its site.
    • Lilly Insulin Value Program: active but expiring — "Card expires and savings end on 12/31/2026". Not relevant to Medicare readers in any case.
    • TotalAssist: the Type 2 diabetes fund pages show "Open" or "Closed" and current award amounts.
    • HealthWell: the disease-funds list shows the Type 2 Diabetes fund and its status.
  3. Step 3 — Check eligibility

    Lilly publishes both the percentage and the dollars, so you can check this yourself:

    • Lilly Cares Group 2 (Lyumjev): no insurance or Medicare Part D, and household annual adjusted gross income at or below 400% of the federal poverty level.
    • Group 2 dollar limits: $63,840 for one person, $86,560 for two, $109,280 for three, $132,000 for four, $154,720 for five, $177,440 for six. Contact Lilly Cares for Alaska and Hawaii figures.
    • You must not be enrolled in Medicaid, full Extra Help or VA benefits, and must not be directed to apply by an employer or plan as a condition of coverage.
    • TotalAssist (when open): government insurance covering Lyumjev; income at or below 500% FPL adjusted for your regional cost-of-living index; a confirmed type 2 diabetes diagnosis.
    • HealthWell (when open): insurance that covers part of the drug's cost, a prescriber-verified type 2 diabetes diagnosis, and treatment in the United States.
  4. Step 4 — Gather your information

    Lilly asks for adjusted gross income specifically, which is a particular figure:

    • Household annual adjusted gross income before taxes, for everyone in the household — your tax return is the usual proof.
    • Household size, counting the applicant and all family members.
    • Medicare card and your Part D or Medicare Advantage drug-plan card.
    • Whether you receive full or partial Extra Help, if any.
    • Your Lyumjev presentation and daily dose — vial, KwikPen U-100, KwikPen U-200, Junior KwikPen or Tempo Pen.
  5. Step 5 — Complete the application

    Who fills out what:

    • Lilly Cares: apply online, or download and print the form (English or Spanish), or call 1-800-545-6962 to have one mailed. There is a provider section for your prescriber.
    • Submit by fax to 1-844-431-6650 or by post to PO Box 501847, San Diego, CA 92150.
    • Extra Help: you (or someone helping you) apply free through Social Security — online, by phone on 1-800-772-1213, or at an office. There is never a fee.
    • TotalAssist (when open): you apply online in about 15 minutes or by phone on 866-512-3861.
  6. Step 6 — Submit and wait for a determination

    What to expect:

    • Lilly Cares: approved patients receive Lyumjev free for up to 12 months, then reapply annually.
    • Extra Help: Social Security notifies you by mail; your Part D plan then applies the lower copays.
    • TotalAssist (when open): an immediate online decision, with proof of income due within 30 days of approval.
  7. Step 7 — If the program is closed or you don't qualify

    The substitution question here needs care, because of the suffix:

    • Ask your prescriber about plain insulin lispro. Several products exist — Humalog, an unbranded insulin lispro from Lilly, and Sanofi's Admelog — but Lyumjev is insulin lispro-AABC, a different formulation, so this is a prescribing decision rather than a substitution.
    • Confirm your plan's insulin cost-sharing: a covered insulin is capped at $35 a month under a Medicare drug plan, with no deductible.
    • If your income is just over the Group 2 limit, check whether it is your adjusted gross income rather than gross income that Lilly measures — the difference sometimes decides it.
    • Apply for Extra Help even if you assume you earn too much; the limits are higher than most people expect.
    • Use the Medicare Prescription Payment Plan to spread this year's out-of-pocket costs across monthly payments.
    • Call Vernal Medicare — we will work through every route above with you, free.

What you'll need

Only items the programs above actually ask for. Gather these before you start.

  • Medicare card and your Part D or Medicare Advantage drug-plan card — plan name, member ID and group number
  • Prescription details — medication name, strength and dose; prescriber name, office phone and address
  • Diagnosis and date of diagnosis — TotalAssist needs the exact date if diagnosed within the past 6 months
  • Household size and annual household income — and proof — tax return, Social Security or pension statements, or pay stubs
  • Your household annual ADJUSTED GROSS income — Lilly Cares measures adjusted gross income, not gross income — your tax return is the usual proof
  • Whether you receive full or partial Medicare Extra Help — Lilly Cares excludes full Extra Help specifically, so the distinction can matter
  • Your Lyumjev presentation and daily dose — vial, KwikPen U-100, KwikPen U-200, Junior KwikPen or Tempo Pen — separate formulary entries

If assistance is unavailable

A closed fund or a denial is not the end of the road. Check these next:

  1. Ask your prescriber about plain insulin lispro products — Humalog, Lilly's unbranded insulin lispro and Sanofi's Admelog. Lyumjev is insulin lispro-aabc, a different formulation, so this is a prescribing decision rather than a straight substitution.
  2. Confirm your plan's insulin cost-sharing. A covered insulin is capped at $35 a month under a Medicare drug plan, and that spending counts toward your out-of-pocket cap. Insulin costs on Medicare
  3. Sign up for TotalAssist fund notifications so you hear the moment a Lyumjev fund reopens — there is no waitlist or queue, so speed matters. TotalAssist notifications
  4. Sign up for HealthWell fund alerts for the same reason; HealthWell says closed funds reopen as funding is replenished. HealthWell disease funds
  5. Check Medicare Extra Help — it does not depend on a fund balance and lowers the cost of every covered drug, not just this one. Extra Help in Utah
  6. Ask your doctor's office — many practices have staff who handle assistance applications routinely and can request a formulary exception or a lower-cost alternative.
  7. Use the Medicare Prescription Payment Plan to spread this year's out-of-pocket costs across monthly payments (it does not lower the total). Medicare.gov
  8. Compare Part D and Medicare Advantage drug plans during the fall enrollment period — the tier and cost-sharing for Lyumjev differ from plan to plan. Part D plans in Vernal

Could Medicare Extra Help reduce your Lyumjev costs?

Extra Help is not a grant for Lyumjev. It is a Medicare program that lowers what qualifying beneficiaries pay for their Part D premium, deductible and every covered prescription — so it is worth checking even when a charitable fund is closed, because it does not depend on fund balances.

Lyumjev is the insulin where the Extra Help question is worth reading carefully rather than assuming. Lilly Cares excludes people enrolled in "full Low Income Subsidy (LIS, 'Extra Help')" — the word full is doing real work, and it makes Lilly's bar narrower than Novo Nordisk's, which excludes anyone who is enrolled in or merely qualifies for Extra Help. If you receive a partial subsidy rather than the full one, ask Lilly Cares directly on 1-800-545-6962 whether you remain eligible; the published wording suggests you might, and it is a question worth asking rather than answering yourself. If you do have full Extra Help, use it: it reduces cost-sharing on every covered drug you take, and a covered insulin is capped at $35 a month regardless.

In 2026, people with full Extra Help generally pay no more than $12.65 for a covered brand-name drug. Income must be below about $23,940 a year for one person ($32,460 for a couple) and countable resources under $18,090 ($36,100 for a couple). Apply free through Social Security — online, by phone at 1-800-772-1213, or in person — and never pay anyone to apply for you.

Government program

Medicare Extra Help (Part D Low-Income Subsidy)

Medicare / Social Security Administration

Accepting applications Medicare: may apply

Status: Year-round federal program (figures for 2026)

Not a grant for one drug — a Medicare program that lowers what qualifying beneficiaries pay for their Part D premium, deductible and every covered prescription.

If you have Medicare: For people with Medicare Part D or a Medicare Advantage drug plan who have limited income and resources.

What it can cover: Part D premium and deductible (often to $0) and reduced copays — generally no more than $12.65 for a covered brand-name drug in 2026 with full Extra Help.

Who may qualify

  • Income below 150% of the federal poverty level — about $23,940 a year for one person or $32,460 for a married couple in 2026.
  • Countable resources (savings, investments — not your home or car) limited to $18,090 for an individual or $36,100 for a married couple living together in 2026 (Medicare.gov figures, which include a burial-expense allowance).
  • Automatic if you have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program.

What the application asks for

  • Social Security number and Medicare number
  • Income (Social Security, pensions, wages) for you and a spouse you live with
  • Value of savings, investments and other countable resources

How to apply

You (or someone helping you) apply free through Social Security — online, by phone, or at a Social Security office. There is never a fee to apply.

Key terms on this page

Patient assistance program (PAP)
A manufacturer program that provides its medication free or at low cost to people who meet income and insurance rules. Many PAPs accept Medicare Part D enrollees; each sets its own criteria.
Copay card / savings card
A manufacturer discount for commercially insured patients. Federal anti-kickback rules mean these cards generally cannot be used with Medicare, Medicaid or other government insurance.
Charitable copay grant
Money from a nonprofit foundation (for example HealthWell or Patient Advocate Foundation) that pays eligible copays or coinsurance for a specific diagnosis. A drug can be listed while the fund is closed to new applicants.
Federal poverty level (FPL)
A federal income measure that assistance programs use as a yardstick — "300% of FPL", "500% of FPL". The percentage is a rule, but the dollar figure behind it comes from a table each program publishes itself, built on a chosen year of the HHS poverty guidelines. Two programs can quote the same percentage in the same year and still list different dollar limits; compare each program against its own table, not against another program.
Medicare Extra Help
The Part D Low-Income Subsidy: a Medicare program that lowers or eliminates Part D premiums, deductibles and copays for beneficiaries with limited income and resources. You apply through Social Security.
Maximum Fair Price (MFP)
The price Medicare negotiated for a selected drug under the Medicare Drug Price Negotiation Program. It applies to Part D plans, not to the pharmacy cash price, and it lowers what plans and enrollees pay for that drug.

Related medication assistance guides

Frequently Asked Questions

Does Medicare cover Lyumjev?
Yes — Medicare Part D and Medicare Advantage drug plans cover Lyumjev, and under federal law a covered insulin costs no more than $35 for a month's supply with no deductible applied. Check your plan's tier for the exact presentation you are prescribed, since the KwikPen U-100, KwikPen U-200 and Junior KwikPen are separate formulary entries. Our insulin cost guide explains how the cap works.
Is there a Lyumjev patient assistance program for people on Medicare?
Yes, and Lilly says so in plain words rather than leaving it to inference. Lyumjev is a Group 2 medication under the Lilly Cares Foundation, and Lilly defines Group 2 as "For patients who have no insurance or have Medicare Part D and have a household annual adjusted gross income ≤ 400% FPL". The dollar limits are published: $63,840 for one person, $86,560 for two, up to $177,440 for six. Approved patients receive Lyumjev free for up to 12 months and reapply annually. The program charges no fee.
I get Extra Help. Does that rule me out of Lilly Cares?
It depends on whether yours is full Extra Help, and the wording matters. Lilly Cares excludes patients "enrolled in Medicaid, full Low Income Subsidy (LIS, 'Extra Help') or Veterans (VA) Benefits". That is narrower than Novo Nordisk's rule, which excludes anyone enrolled in or merely qualifying for Extra Help. If you receive a partial subsidy, call Lilly Cares on 1-800-545-6962 and ask rather than assuming — this is exactly the kind of distinction that decides an application.
Can I use Lilly's $35 insulin card with Medicare?
No. Lilly's terms require that "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." Lilly states the reason plainly itself: "Government restrictions exclude people enrolled in federal government insurance programs from Lilly's $35 solutions." The practical loss is small, because federal law already caps a covered insulin at $35 a month under a Medicare drug plan — and unlike the card, that spending counts toward your annual out-of-pocket cap. The card also expires on 12/31/2026.
Is there a generic for Lyumjev?
Not for Lyumjev itself. Lyumjev is insulin lispro-aabc — a distinct formulation designed to act faster — and DailyMed lists it as the only product with that suffix. There are several plain insulin lispro products: Lilly's Humalog and its unbranded insulin lispro, and Sanofi's Admelog, across 16 labelled products and six labelers in total. Those are different medicines rather than interchangeable versions of Lyumjev, so switching is a prescribing decision for your doctor, not a substitution at the pharmacy counter.
Is Lyumjev part of Medicare drug price negotiation?
No. CMS's selected-drug and Maximum Fair Price file has no Lyumjev or insulin lispro row for initial price applicability year 2026, 2027 or 2028. The only insulin CMS has ever selected is Novo Nordisk's insulin aspart, sold as NovoLog and Fiasp, for 2026 — a different product from a different manufacturer, and its negotiated price does not apply here. See all prescription assistance options.

Sources

Having trouble figuring out your prescription costs?

If you live in Vernal or the Uintah Basin, Vernal Medicare can help you understand your Medicare prescription coverage and where to look for Lyumjev assistance — free, no pressure. We don't award grants or decide eligibility; the programs above do. We help you find and apply to the right ones.

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