GLP-1 Patient Assistance Programs: Who Qualifies for Free Medication?

A patient assistance program (PAP) is a manufacturer-run charity program that provides brand-name medication free of charge to people who can't otherwise afford it. Both major GLP-1 manufacturers — Novo Nordisk (maker of Ozempic and Wegovy) and Eli Lilly (maker of Mounjaro and Zepbound) — run their own PAPs, separate from the manufacturer savings cards you may have seen advertised.

The distinction matters: savings cards reduce your out-of-pocket cost when your insurance already covers the drug (and typically require commercial insurance to use). PAPs are designed for people who have no coverage at all, or whose insurance specifically excludes or denies the medication, and they provide the medication for free rather than at a discount. Because PAPs are funded as charitable programs rather than marketing tools, they come with stricter income and documentation requirements, and approval isn't guaranteed just because you apply.

Novo Nordisk's PAP requires that you be a U.S. citizen or legal resident with no insurance, or Medicare coverage only — private or commercial insurance generally disqualifies you from this program entirely, regardless of income. Income limits are based on the Federal Poverty Level (FPL) and vary by medication: for Ozempic specifically, uninsured applicants must have income at or below 200% of FPL, while most other Novo Nordisk medications on the program's list allow up to 400% of FPL for uninsured applicants.

Medicare beneficiaries have a separate, more complex pathway: those with income below 150% FPL generally need to show proof they were denied Extra Help (the Medicare Low-Income Subsidy) before qualifying, and Medicare recipients seeking insulin coverage specifically can qualify at up to 400% FPL. You cannot combine this program with Medicaid, Medicare Extra Help, or VA benefits — the program assumes you have no other assistance pathway available, and applicants already enrolled in those programs need to seek help through them instead.

The Lilly Cares Foundation sets its income eligibility at roughly 300–400% of the federal poverty level, which translates to approximate household income thresholds of about $45,000–$60,000 for a single person and $93,000–$125,000 for a household of four, though exact figures are updated annually and should be confirmed on the current application. Unlike Novo Nordisk's program, having Medicare or Medicaid doesn't automatically disqualify you — there are separate eligibility pathways for people with government insurance, though the core criterion remains no adequate coverage for the specific medication.

"No adequate coverage" is broader than simply being uninsured: it also includes situations where your existing insurance denies prior authorization or has a formulary exclusion for Zepbound or Mounjaro. That's a meaningful detail, because it means someone with commercial insurance who has been formally denied coverage may still be able to apply. You'll also need a qualifying diagnosis — type 2 diabetes for Mounjaro, or obesity/overweight with a related health condition for Zepbound — and a participating prescriber willing to co-sign your application. The foundation verifies actual income documentation rather than accepting self-reported numbers, so it's worth applying even in borderline cases rather than assuming you won't qualify.

Both programs require proof of income (recent tax returns, pay stubs, or a signed income attestation form depending on the program), proof of U.S. residency, and a completed application co-signed by your prescribing clinician confirming your diagnosis and medical need. If you're applying based on an insurance denial or formulary exclusion rather than being fully uninsured, you'll also need documentation of that denial — typically the explanation-of-benefits letter or the formal denial notice from your insurer.

Applications are typically renewed annually, so plan to reapply and resubmit updated income documentation each year you need continued assistance. Processing times vary, and having your prescriber's office actively involved — since they need to co-sign — tends to be the biggest factor in how quickly an application moves, so it helps to ask your clinic's staff whether they've submitted these applications before.

A denial isn't necessarily the end of the road, and it can actually work in your favor for Lilly Cares Foundation eligibility as described above. Your first step should usually be a formal appeal with your insurer, since many initial GLP-1 denials are overturned when a prescriber submits additional documentation of medical necessity — a process that's separate from, and can run in parallel with, a PAP application.

If the appeal fails or your plan has a blanket exclusion for weight-loss medications (common in many employer plans), a PAP application becomes a more direct path, particularly for Zepbound and Mounjaro given Lilly Cares Foundation's broader definition of "no adequate coverage." It's worth pursuing both routes simultaneously rather than waiting for one to fully resolve before starting the other, since PAP processing and insurance appeals can each take several weeks.

If your income is above the PAP thresholds or you have insurance that covers the medication (even with a high copay), a few other paths are worth exploring. Manufacturer savings cards can significantly lower out-of-pocket costs for people with commercial insurance that covers the drug but at a high copay. Direct-pay pricing through LillyDirect or NovoCare offers self-pay options at a lower list price than typical retail pharmacy pricing, which can help people without coverage who don't qualify for a PAP.

It's also worth checking whether your FSA or HSA funds can be applied toward your medication cost, and whether your employer's health plan has a separate weight-management benefit that isn't obvious from your standard formulary. None of these options provide free medication the way a PAP does, but layering the right combination — an appeal, a savings card, and direct-pay pricing for months not covered by insurance — can meaningfully lower your total annual cost even without full assistance program approval.