Smiling man wearing salmon-colored shirt

Starting Taltz has never been easier

Hypothetical Patient

Starting Taltz has never been easier

Taltz Savings Card

For eligible, commercially insured patients

Access regardless of treatment history or formulary requirements for as little as $5 or $25 per month, for up to 24 months.* See below for Terms and Conditions. Governmental beneficiaries excluded, terms and conditions apply.

Text "Taltz" to 85099 to access savings and support or to activate your patient's savings card.

What are the steps to start a patient on Taltz?

Enrollment Forms

Start with a Taltz Enrollment Form, which serves as the Taltz prescription.

Adult Dermatology Enrollment Form

Pediatric Dermatology Enrollment Form

Adult Rheumatology Enrollment Form

For more information about Lilly’s privacy practices, please view the Privacy Statement.

Digital Enrollment

Lilly Patient Support Provider Portal

With the Lilly Patient Support Provider Portal, office sites are able to digitally enroll patients in Taltz Together and utilize services to help with access and coverage assistance.

The Lilly Patient Support Provider Portal provides:

Simplified and easy-to-use digital enrollment process
Convenient electronic options to obtain patient Health Insurance Portability and Accountability Act (HIPAA) authorization signature
Ability to view real-time patient status information and case history for all patients enrolled by the office (fax, phone, or Provider Portal)
Enables HCP offices to receive reminder alerts for important tasks necessary to help patients start treatment as early as possible
Secure Messaging Feature allows users to communicate directly with Taltz Together regarding their cases and patients
Access eEligibility (electronic eligibility) or ePA (electronic prior authorization) services to confirm patients’ eligibility and coverage (summary of benefits)

Your patients can now enroll directly in Taltz Together^™ with the Lilly Together^™ app.

To get started, patients can search for “Lilly Together” in the App Store^® or on Google Play^™ to download the app.

Once signed in, patients can:

Access their savings card information directly through the app so it's always with them.
Set up a dosing plan and reminders.
Use symptom tracking to help them understand progress and stay motivated on treatment, and give you a more complete view of their symptom information all in one place the next time you meet.
Connect with a Companion in Care^™ team member for ongoing support.
Browse helpful resources and hear from other patients on Taltz all inside the app.

Office sites will be able to digitally enroll patients in Taltz Together and utilize services to help with access and coverage assistance.

Taltz Together Offerings include:

Insurance Investigation

Help with preliminary insurance investigation and specialty pharmacy identification

Injection Training

Free of charge to patients and their families
Patients can choose either in-person or telephone training
Injection training videos available here, or through the Lilly Together^™ app

Ongoing Support

A personal patient resource to help answer questions or concerns
Help is available Monday-Friday from 8 AM to 10 PM ET
Available for patients who use the Lilly Together^™ app

Field Reimbursement Support

The Field Reimbursement Manager is an experienced access professional who can help your patients navigate the complex access and reimbursement environment.

The managers are:

Knowledgeable: understand Taltz Together services, access challenges, and affordability options
Connected: integrated with the Taltz Together call center and understand the Taltz contracted specialty pharmacy network
Patient Focused: committed to providing information to support patient access to Taltz

Sharps Container Support

Allows patients to safely dispose of Taltz sharps in an FDA-cleared sharps disposal container. Once the container is full, your patient should put the container lid on and follow the patient community guidelines for the right way to dispose of their sharps disposal container. Sharps containers should not be recycled. Your patient can contact Taltz Together to receive another one.

**Eligible, commercially insured patients who are taking Taltz and are also prescribed Zepbound^® (tirzepatide) Injection may be eligible to pay as little as $30 per month for both products^*†**

Patients can pay as little as $5 for Taltz and $25 for Zepbound per month. Taltz must be covered by the patient’s commercial drug insurance plan and the patient must be filling their Taltz prescription. Additional terms, conditions, and limitations apply.
^*Governmental beneficiaries excluded, terms and conditions apply.

Eligible patients interested in learning more about Zepbound Savings for Taltz Patients must call Taltz Together at 1-844-TALTZ-NOW (1-844-825-8966).

In order to be eligible for the Zepbound Savings for Taltz patients, patients must:

Have been prescribed Zepbound and Taltz (independently) and have diagnoses that are consistent with FDA approved product labeling;
Have commercial drug insurance that covers Taltz;
Have filled their Taltz prescription within the preceding 30 days of filling their Zepbound prescription;
Be enrolled in the Taltz Together program;
Not be enrolled in any state, federal, or government funded healthcare program;
Be 18 years of age or older and a resident of the United States or Puerto Rico.

Additional terms, conditions, and limitations apply. Governmental beneficiaries excluded. See full terms and conditions below.

For patients to enroll in Zepbound Savings for Taltz Patients:

The HCP must submit a completed Taltz Together Enrollment Form
- Enrollment Forms can be submitted in one of four ways:
  1. Through CoverMyMeds^®
  2. Through the Lilly Patient Support Provider Portal
  3. Via Fax: 1-844-344-8108
  4. Or via upload to patientsupportnow.org using code 8443448108
If required by the patient’s insurer, the HCP must also submit a completed Taltz Prior Authorization Form

^†One month is defined as 28 days and 4 pens for Zepbound.

Please see Prescribing Information including Boxed Warning and Medication Guide for Zepbound. See Instructions for Use included with the device.

Terms and Conditions
By enrolling in the Zepbound Savings for Taltz Patients Savings Card Program (“Program”) and using the Zepbound Savings for Taltz Patients 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:
(1.) You have been prescribed Zepbound® (tirzepatide) and have a diagnosis that is consistent with FDA approved product labeling;
(2.) You have been prescribed Taltz® (ixekizumab) and have a diagnosis that is consistent with FDA approved product labeling;
(3.) You have commercial drug insurance that covers Taltz;
(4.) You have filled your Taltz prescription within the preceding 30 days of filling your Zepbound prescription;
(5.) You are enrolled in the Taltz Together program;
(6.) 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;
(7.) You are a resident of the United States or Puerto Rico; and
(8.) You are 18 years of age or older.

Card Terms and Conditions
For patients with commercial drug insurance coverage for Zepbound: In order to be eligible to pay as little as $25 for a 1-month, 2-month, or 3-month prescription fill of Zepbound, you must: (a) have commercial drug insurance that covers Zepbound and a prescription and diagnosis consistent with FDA-approved product labeling; and (b) have commercial insurance with coverage for Taltz and have filled your Taltz prescription within the preceding 30 days of filling your Zepbound prescription. Month is defined as 28-days and up to 4 pens. Card savings are subject to a maximum monthly savings of up to $295 per 1-month prescription, $590 per 2-month prescription, or $885 per 3-month prescription fill and separate maximum annual savings of up to $2,950 per calendar year. Card may be used for a maximum of up to 10 prescription fills per calendar year. If you discontinue filling your Taltz prescription for any reason, you may use this Card on or before 12/31/2024 for a maximum of one additional prescription fill, to pay as little as $25 for a 1-month, 2-month, or 3-month supply of Zepbound. After you have utilized this one additional prescription fill of Zepbound following discontinuation of Taltz, you will no longer be eligible to use this Card. 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 12/31/2024.

For patients with commercial drug insurance who do not have coverage for Zepbound: In order to be eligible to pay as little as $25 for a 1-month prescription fill of Zepbound, you must: (a) have commercial drug insurance that does not cover Zepbound and a prescription and diagnosis consistent with FDA-approved product labeling; and (b) have commercial insurance with coverage for Taltz and have filled your Taltz prescription within the preceding 30 days of filling your Zepbound prescription. Month is defined as 28-days and up to 4 pens. Card savings are subject to a maximum monthly savings of wholesale acquisition cost plus usual and customary pharmacy charges for one 28-day supply of Zepbound. Card may be used for a maximum of up to 10 prescription fills per calendar year. If you discontinue filling your Taltz prescription for any reason, you may use this Card on or before 12/31/2024 for a maximum of one additional prescription fill, to pay as little as $25 for a 1-month supply of Zepbound. After you have utilized this one additional prescription fill of Zepbound following discontinuation of Taltz, you will no longer be eligible to use this Card. 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 12/31/2024.

Additional Terms and Conditions
If you have an insurance plan that is participating in an alternate funding program (“AFP”) (examples include, but are not limited to, ImpaxRX, Payer Matrix, SHARx, Script Sourcing, and Paydhealth) that requires you to apply to the Zepbound Savings for Taltz Patients 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 Zepbound, you are not eligible for and are prohibited from using the Zepbound Savings for Taltz Patients 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 the Zepbound Savings for Taltz Patients Savings Card Program. You agree to inform the Zepbound Savings for Taltz Patients 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 Zepbound, only allows partial coverage for Zepbound, removes coverage for Zepbound and requires you to utilize the Card, does not provide a material level of financial assistance for the cost of Zepbound, or does not apply Card payments to satisfy your co-payment, deductible, or coinsurance for Zepbound. 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. Card activation is required. No party may 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 Zepbound. You agree that this Card savings is intended solely for the benefit of you, the patient, and that the Card benefits are nontransferable. It is prohibited for any person to sell, purchase, or trade; or to offer to sell, purchase, or trade, or to counterfeit the Card .The 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 Zepbound Savings for Taltz Patients Savings Card Program may change from time to time. 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, the Card expires and savings end on 12/31/2024.

By enrolling in the Taltz Savings Card Program (“Program”) and using the Taltz Savings Card (“Card”), you attest that you meet the eligibility criteria, agree to, and will comply with the terms and conditions described below:

Card Eligibility:

You have been prescribed Taltz^® (ixekizumab) consistent with FDA approved product labeling
You are enrolled in a commercial drug insurance plan
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
You are 18 years of age or older

Card Terms and Conditions:

For patients with commercial drug insurance coverage for Taltz: You must have commercial drug insurance that covers Taltz and a prescription consistent with FDA-approved product labeling to pay as little as $5 for a 1-month prescription fill of Taltz. Month is defined as 28-days and up to 3 pens. Card must be first used by no later than 12/31/2024. Card savings are subject to a maximum monthly savings of wholesale acquisition cost plus usual and customary pharmacy charges and a separate maximum annual savings of up to $9,450 per calendar year. Card may be used for up to a maximum of 14 prescription fills per calendar year and up to a maximum of 24 prescription fills over the lifetime of the Program, subject to the previously stated maximum monthly and annual savings limit. Participation in the Program requires a valid patient HIPAA authorization upon enrollment into the Program. Subject to Lilly USA, LLC’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 or 24 months after you first use the Card, whichever comes first.

For patients with commercial drug insurance who do not have coverage for Taltz: You must have commercial drug insurance that does not cover Taltz and a prescription consistent with FDA-approved product labeling to pay as little as $25 for a 1-month supply of Taltz. Month is defined as 28-days and up to 3 pens. Card savings are subject to a maximum monthly savings and a separate maximum annual savings. Card may be used for up to a maximum of 14 prescription fills per year and up to a maximum 24 prescription fills over the lifetime of the Program, subject to the maximum monthly and annual savings limit. Card must be first used by no later than 12/31/2024. Participation in the Program requires submission of a prior authorization (PA) prior to the first prescription fill. If coverage is denied, an appeal must be submitted prior to 5th month prescription fill. To remain eligible for the Program, a new PA, appeal, or medical exception must be submitted prior to the 13th prescription fill and as required by Lilly at its sole discretion. Participation in the Program requires a valid patient HIPAA authorization to remain in the Program. Subject to Lilly USA, LLC’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 or 24 months after you first use the Card, whichever comes first.

Additional Program Terms and Conditions

If you have an insurance plan that is participating in an alternate funding program (“AFP”) (examples include, but are not limited to, ImpaxRX, Payer Matrix, SHARx, Script Sourcing, and Paydhealth) that requires you to apply to the Taltz 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 Taltz, you are not eligible for and are prohibited from using the Taltz 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 Taltz Savings Card Program. You agree to inform Taltz 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 Taltz, only allows partial coverage for Taltz, removes coverage for Taltz and requires you to utilize the Card, does not provide a material level of financial assistance for the cost of Taltz, or does not apply Card payments to satisfy your co-payment, deductible, or coinsurance for Taltz. 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 Taltz Savings Card and agree to call the Taltz Savings Card Program at 1-844-825-8966 to stop participation. Card activation is required. No party may 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 Taltz. You agree that this Card savings is intended solely for the benefit of you, the patient, and that the Card benefits are nontransferable. It is prohibited for any person to sell, purchase, or trade; or to offer to sell, purchase, or trade, or to counterfeit the Card. The 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. Eligibility criteria, and terms and conditions for the Taltz Savings Card Program may change from time to time; the most current version can be found at https://www.Taltz.com. 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, the Card expires and savings end on 12/31/2026 or 24 months after you first use the Card, whichever comes first.

TRICARE^® is a registered trademark of the Department of Defense (DoD), DHA.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS:

Taltz is contraindicated in patients with a previous serious hypersensitivity reaction, such as anaphylaxis, to ixekizumab or to any of the excipients.

WARNINGS AND PRECAUTIONS

Infections
Taltz may increase the risk of infection. In clinical trials of adult patients with plaque psoriasis, the Taltz group had a higher rate of infections than the placebo group (27% vs 23%). A similar increase in risk of infection was seen in placebo-controlled trials of adult patients with psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and pediatric patients with plaque psoriasis. Serious infections have occurred. Instruct patients to seek medical advice if signs or symptoms of clinically important chronic or acute infection occur. If a serious infection develops, discontinue Taltz until the infection resolves.

Pre-Treatment Evaluation for Tuberculosis
Evaluate patients for tuberculosis (TB) infection prior to initiating treatment with Taltz. Do not administer to patients with active TB infection. Initiate treatment of latent TB prior to administering Taltz. Closely monitor patients receiving Taltz for signs and symptoms of active TB during and after treatment.

Hypersensitivity
Serious hypersensitivity reactions, including angioedema and urticaria (each ≤ 0.1%), occurred in the Taltz group in clinical trials. Anaphylaxis, including cases leading to hospitalization, has been reported in post-marketing use with Taltz. If a serious hypersensitivity reaction occurs, discontinue Taltz immediately and initiate appropriate therapy.

Inflammatory Bowel Disease
Patients treated with Taltz may be at an increased risk of inflammatory bowel disease. In clinical trials, Crohn's disease and ulcerative colitis, including exacerbations, occurred at a greater frequency in the Taltz group than the placebo group. During Taltz treatment, monitor patients for onset or exacerbations of inflammatory bowel disease and if IBD occurs, discontinue Taltz and initiate appropriate medical management.

Immunizations
Prior to initiating therapy with Taltz, consider completion of all age-appropriate immunizations according to current immunization guidelines. Avoid use of live vaccines in patients treated with Taltz.

ADVERSE REACTIONS

Most common adverse reactions (≥1%) associated with Taltz treatment are injection site reactions, upper respiratory tract infections, nausea, and tinea infections. Overall, the safety profiles observed in adult patients with psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and pediatric patients with plaque psoriasis were consistent with the safety profile in adult patients with plaque psoriasis, with the exception of influenza and conjunctivitis in psoriatic arthritis and conjunctivitis, influenza, and urticaria in pediatric psoriasis.

Please see Prescribing Information and Medication Guide. Please see Instructions for Use included with the device.

IX HCP ISI 07MAY2020

INDICATIONS

Taltz is indicated for adults with active psoriatic arthritis (PsA), for adults with active ankylosing spondylitis (AS), and for adults with active non-radiographic axial spondyloarthritis (nr-axSpA) with objective signs of inflammation. Taltz is also indicated for patients aged 6 years or older with moderate-to-severe plaque psoriasis (PsO) who are candidates for systemic therapy or phototherapy.

Taltz Savings Card

For eligible, commercially insured patients

Access regardless of treatment history or formulary requirements for as little as $5 or $25 per month, for up to 24 months.* See below for Terms and Conditions. Governmental beneficiaries excluded, terms and conditions apply.

Text "Taltz" to 85099 to access savings and support or to activate your patient's savings card.

What are the steps to start a patient on Taltz?

Access Taltz through a specialty pharmacy that is convenient for patients.

Prior Authorization Outcome:

Approved:

Denied:

Services

Enrollment Forms