Resource Request Form

Additional Formulary Plan Information

*Represents Medicaid formulary data ||| caption

Source: Managed Markets Insight & Technology (MMIT), LLC as of 10/01/2025, and is subject to change without notice by a health plan or state. Please contact the plan or state for the most current information.

This information is not a guarantee of coverage or payment (partial or full). Actual benefits are determined by each plan administrator in accordance with its respective policy and procedures.

This list may not be an exhaustive list of plans in your area and the coverage of other plans in your area may vary.

Employers and employer groups may also offer additional benefit designs which may be different than described.

The company/plan names listed do not imply their endorsement of Lilly USA, LLC or the product referenced.

Lilly USA, LLC does not endorse any particular plan. Other product and company names mentioned herein are the trademarks of their respective owners.