If you've been quoted a cash price north of $1,000 a month for a GLP-1 medication, you've probably landed on two names within minutes of searching: NovoCare and Lilly Cares. They sound similar, they solve the same basic problem — unaffordable brand-name medication — and marketing pages rarely explain how different their rules actually are.
The short version: NovoCare belongs to Novo Nordisk and only helps with Novo Nordisk drugs. Lilly Cares Foundation belongs to Eli Lilly and only helps with Eli Lilly drugs. If your prescriber has you on Ozempic, Rybelsus or a Novo Nordisk insulin, Lilly Cares can't help you no matter how low your income is, and vice versa for Mounjaro.
This guide walks through both programs side by side — who they're actually for, what income limits look like heading into the back half of 2026, which drugs are (and aren't) reliably covered, and what a complete application needs so you're not sent back for missing paperwork.
Table of Contents
- NovoCare vs Lilly Cares: The Core Difference
- Side-by-Side Comparison Table
- NovoCare Eligibility & Income Limits
- Lilly Cares Eligibility & Income Limits
- Which Drugs Each Program Actually Covers
- Medicare and Medicaid Patients: What Changed for 2026
- Decision Tree: Which Program Should You Apply To?
- How to Apply — Step by Step
- Common Reasons Applications Get Denied
- What to Do If You're Denied
- Frequently Asked Questions
NovoCare vs Lilly Cares: The Core Difference
NovoCare is the umbrella patient-support brand for Novo Nordisk. Under that umbrella sits the Novo Nordisk Patient Assistance Program (PAP) — the piece that actually provides free medication to income-qualifying, uninsured patients. NovoCare also hosts separate savings-card programs for commercially insured patients, but those are a different mechanism from the PAP.
Lilly Cares Foundation is Eli Lilly's independent charitable foundation. It runs its own PAP for Eli Lilly medications, following a similar general shape — income-based eligibility, uninsured-patient focus, prescriber-submitted applications — but with its own thresholds, its own covered-drug list and its own paperwork.
The two programs are administered completely independently. There's no shared application, no shared income database and no reciprocity. If you take one Novo Nordisk drug and one Eli Lilly drug, you would need to apply to both programs separately, in full.
Side-by-Side Comparison Table
| Feature | NovoCare (Novo Nordisk) | Lilly Cares Foundation (Eli Lilly) |
|---|---|---|
| Administered by | Novo Nordisk | Eli Lilly and Company |
| Program type | Manufacturer Patient Assistance Program | Independent charitable foundation PAP |
| Core requirement | Uninsured, or Medicare with documented denial | Uninsured or inadequately insured |
| Typical income limit | 200% FPL (Ozempic, uninsured) / 400% FPL (other drugs) | Roughly 300%–400% FPL |
| Diabetes drug covered | Ozempic, Rybelsus, Victoza, insulins | Mounjaro |
| Weight-management drug | Disputed — verify Wegovy status directly | Disputed — verify Zepbound status directly |
| Medicare Part D patients | Largely excluded for Ozempic since most Part D plans cover it | May qualify if plan denies coverage; separate review |
| Application submitted by | Prescriber + patient | Prescriber + patient |
| Typical processing time | 1–4 weeks | 2–4 weeks |
| Renewal cycle | Periodic requalification | Up to 12 months, annual reapplication |
Both manufacturers updated their rules for 2026. Some third-party guides published earlier in the year still describe the older eligibility rules. Treat any number you find — including the ones in this guide — as a starting point, and confirm the current figure on novocare.com or lillycares.com before your provider submits paperwork.
NovoCare Eligibility and Income Limits
NovoCare's Patient Assistance Program eligibility depends heavily on which drug is being requested and what other coverage you have. For 2026, the program generally separates uninsured patients from Medicare patients, and separates Ozempic from the rest of the formulary.
| Patient Situation | Income Limit | Additional Requirement |
|---|---|---|
| Uninsured, requesting Ozempic | ≤200% FPL | Proof of Medicaid denial if income meets state threshold |
| Uninsured, other Novo Nordisk drugs | ≤400% FPL | Standard PAP documentation |
| Medicare, no Part D coverage | ≤150% FPL | Proof of denial for Part D Extra Help (LIS) |
| Medicare with Part D drug coverage | Not eligible for Ozempic PAP | Most Part D plans now cover Ozempic directly |
| Enrolled in Medicaid | Not eligible | Medicaid is considered adequate coverage |
The tightening of Ozempic eligibility for Medicare patients is one of the more significant 2026 changes. Novo Nordisk has pointed to broad Part D coverage of Ozempic as the reasoning, which means Medicare beneficiaries who previously received free Ozempic through the PAP may now need to lean on Part D coverage, the Medicare Prescription Payment Plan, or a savings card instead.
What NovoCare Typically Requires You to Submit
- Completed application signed by the prescriber
- Proof of household income (pay stubs, tax return, or a signed attestation)
- Proof of no insurance, or proof of Medicaid/Extra Help denial where applicable
- Valid, active prescription for the requested medication
Lilly Cares Eligibility and Income Limits
Lilly Cares Foundation eligibility follows the same basic shape — U.S. residency, no adequate insurance coverage, and household income under a set percentage of the federal poverty level — but the foundation applies its own thresholds and its own review process, separate from any Novo Nordisk program.
| Patient Situation | Typical Requirement |
|---|---|
| Household income | Generally at or below 300%–400% FPL |
| Insurance status | Uninsured, or insured with a plan that excludes the drug |
| Medicare/Medicaid patients | Not automatically disqualified — reviewed against separate criteria |
| Residency | U.S. citizen or lawful permanent resident |
| Prescription | Valid prescription from a participating prescriber |
Rough income reference: Guides published in 2026 place the 400% FPL cutoff at roughly $63,000 for a household of one. Household-size figures update annually, so check the current Federal Poverty Guidelines on NeedyMeds.org and cross-reference against the Lilly Cares application rather than relying on last year's numbers.
Lilly also runs the Insulin Value Program, which is frequently confused with Lilly Cares in search results. The Insulin Value Program caps the price of insulin — it has nothing to do with Mounjaro, Zepbound, or Lilly Cares eligibility. If you're looking for GLP-1 assistance and land on an insulin program instead, you're on the wrong page.
Which Drugs Each Program Actually Covers
This is where patients get tripped up most often, because coverage for weight-management drugs specifically has shifted during 2026 and reputable sources currently disagree.
| Medication | Manufacturer | Indication | PAP Coverage Status |
|---|---|---|---|
| Ozempic | Novo Nordisk | Type 2 diabetes | Covered for uninsured only; Medicare largely excluded in 2026 |
| Rybelsus | Novo Nordisk | Type 2 diabetes | Generally covered |
| Victoza | Novo Nordisk | Type 2 diabetes | Generally covered |
| Wegovy | Novo Nordisk | Chronic weight management | Sources disagree — confirm directly with NovoCare |
| Mounjaro | Eli Lilly | Type 2 diabetes | Generally covered under Lilly Cares |
| Zepbound | Eli Lilly | Chronic weight management | Sources disagree — several report it is currently excluded |
Why the disagreement? Weight-management indications are newer, higher-demand and more expensive to subsidize than long-established diabetes drugs. Manufacturer PAP formularies for these drugs have moved more than once in the past two years, and many third-party comparison sites haven't been updated to match. Before assuming Wegovy or Zepbound is or isn't covered, call the program directly or check the official eligibility page dated for the current year.
Medicare and Medicaid Patients: What Changed for 2026
Both programs exist primarily for uninsured patients, but each carved out narrower paths for people with Medicare or Medicaid — and both paths got stricter heading into 2026.
Medicare Part D coverage is checked first
If your Part D plan already lists the medication on its formulary, most PAP applications will be denied regardless of income, because the coverage gap the program is meant to fill doesn't exist for you.
A documented denial is usually required
If you believe you qualify despite having Medicare, both programs generally want a denial letter — either a Part D Extra Help (Low-Income Subsidy) denial or a formulary exclusion notice — attached to the application.
Medicaid is treated as adequate coverage
Enrollment in Medicaid typically disqualifies a patient from either PAP outright, since Medicaid is considered sufficient prescription coverage in most states. State-specific formulary gaps are the main exception, and those require separate documentation.
If Medicare or Medicaid already covers your medication but the copay is still unaffordable, a patient assistance program isn't the right tool — a state pharmaceutical assistance program, a manufacturer copay card (where allowed), or a nonprofit copay foundation like the PAN Foundation or HealthWell Foundation is a better fit.
Decision Tree: Which Program Should You Apply To?
What drug were you prescribed?
Identify the manufacturer first — this decides everything
Uninsured?
Check income against 200%–400% FPL by drug
Apply to NovoCare PAP
Prescriber submits application + income proof
Uninsured or excluded?
Check income against roughly 300%–400% FPL
Apply to Lilly Cares
Prescriber submits application + income proof
Insured but drug excluded?
Both programs may still consider "inadequate coverage" cases
Denied?
Appeal, or look at copay foundations and state programs
How to Apply — Step by Step
The application mechanics for NovoCare and Lilly Cares are similar enough that the same general workflow applies to both, even though the forms themselves are different.
Confirm the manufacturer
Check the label or ask your pharmacist which company makes your medication. Applying to the wrong program wastes weeks.
Gather income documentation
Recent pay stubs, a tax return, or a Social Security award letter for every income-earning household member. Some applications accept a signed income attestation if no documentation exists.
Confirm insurance status
If you have Medicare or Medicaid, get a denial letter or formulary exclusion notice in hand before submitting — this is the single most common missing document.
Have your prescriber complete their section
Both programs require prescriber sign-off. Confirm your provider's office is willing to complete PAP paperwork — some clinics designate a specific staff member for this.
Submit and track
Applications can typically be submitted online or by mail/fax. Keep a copy of everything submitted and note the date, since most approvals require annual or periodic renewal.
Common Reasons Applications Get Denied
| Reason | What It Usually Means |
|---|---|
| Applied to the wrong program | Medication manufacturer doesn't match the program |
| Income above threshold | Household income exceeds the FPL cutoff for that drug |
| Existing coverage | Insurance, Medicare Part D or Medicaid already covers the drug |
| Missing denial letter | Required for Medicare/Medicaid patients claiming inadequate coverage |
| Incomplete prescriber section | Provider signature or NPI number missing |
| Expired documentation | Income proof or insurance denial letter too old to be accepted |
What to Do If You're Denied
1. Read the denial reason carefully. Both programs typically state why a request was declined, and many denials are administrative rather than a final "no."
2. Ask about the appeal window. Lilly Cares generally reviews appeals within about 30 days when submitted with corrected documentation; NovoCare allows reapplication once missing items are resolved.
3. Look at the manufacturer's cash-pay channel. LillyDirect and Novo Nordisk's direct programs sometimes offer reduced cash pricing that's far below retail even without PAP approval.
4. Check independent copay foundations. Organizations such as NeedyMeds, RxAssist and the HealthWell Foundation run separate funds that sometimes cover GLP-1 medications when manufacturer programs don't.
5. Ask about state pharmaceutical assistance programs. A handful of states run their own senior or low-income drug assistance programs that operate independently of either manufacturer.
Frequently Asked Questions
No. NovoCare is Novo Nordisk's support program and Lilly Cares Foundation is Eli Lilly's separate charity. Each one only covers medications made by its own company.
Yes, if you take medications from both manufacturers. You'll need a separate, complete application for each program — there's no shared form or shared review.
Not automatically, but the bar is higher. You typically need proof that Part D coverage or Extra Help was denied, and for Ozempic specifically, Medicare patients are largely excluded from the NovoCare PAP as of 2026 because most Part D plans already cover it.
This is unsettled and sources disagree. Coverage for weight-management drugs under both PAPs has changed more than once. Confirm the current covered-drug list directly with NovoCare or Lilly Cares before submitting an application built around either drug.
Most complete applications to either program are reviewed within two to four weeks. Missing documentation is the most common cause of longer delays.
Yes. Both programs require a prescriber to complete and sign a portion of the application confirming diagnosis and medical necessity.
You generally won't qualify for the manufacturer PAP, but independent copay foundations and manufacturer cash-pay programs sometimes have separate, higher income allowances or no income requirement at all.
Yes. Both programs generally require the applicant to be a U.S. citizen or lawful permanent resident with a prescription from a U.S.-licensed prescriber.
The savings card is a copay-reduction tool for people who already have commercial insurance. Lilly Cares is a separate charitable program that provides free medication to uninsured, income-qualifying patients. They serve different populations and can't be combined.
Approvals are generally granted for a defined period — often up to 12 months — after which the patient must requalify with updated income and insurance documentation.
How We Researched This Guide
References
- NovoCare — Novo Nordisk Patient Assistance Program eligibility
- Lilly Cares Foundation — eligibility and application information
- NeedyMeds — current Federal Poverty Level guidelines
- HealthWell Foundation — independent copay assistance
- Patient Access Network (PAN) Foundation
Related Resources
- Ozempic Prior Authorization Requirements
- How to Appeal a Prescription Denial
- Medicare GLP-1 Bridge Program
- Ozempic for Weight Loss
- Mounjaro Drug Guide
Editorial Policy: Refill Relay medical content is researched using manufacturer patient assistance program pages, Federal Poverty Level guidance, and current third-party reporting on 2026 program changes. Because manufacturer PAP rules can change without notice, always confirm income limits and covered-drug lists directly with NovoCare or Lilly Cares before submitting an application.