US Dossier Inquiry Form

This form is intended for US Healthcare Professionals that are actively working in their capacity in healthcare, formulary and/or benefit design roles.

Please complete the required fields below. Your request will be triaged appropriately and a response will be provided to you in a timely manner.

For any other questions or to report an Adverse Event or Product Complaint, please contact 1-800-LILLYRX (1-800-545-5979).

Fields with (*) are mandatory

First Name *

Last Name *

Organization *

Department/Role *

Email *

Phone *

Product *

CONFIRMATION OF APPROPRIATE USE

Lilly's AMCP Dossiers are intended for those individuals who are actively working in a capacity where health care, formulary, and/or benefit designs are part of their role. This could include-but is not limited to-P&T committee members, clinical pharmacists reponsible for reviewing medications or managing formularies, and individuals who work with health plans to develop, implement, or advise on various benefit designs.
Lilly's AMCP Dossiers ARE NOT intended for physicians, pharmacists or patients seeking prescribing information.
Lilly's AMCP Dossiers ARE NOT intended for use by individuals representing or employed by pharmaceutical, biotechnology, medical device manufacturers, or other industries not directly involved in health benefit design and provision. Such individuals are not eligible to recieve Lilly's AMCP Dossiers.

I affirm that I am an appropriate user of Lilly's AMCP Dossier, as noted above.

For more information about Lilly's privacy practice, please view the Privacy Statement.