Patient Assistance - Diabetes Care
The Cornerstones4Care® Patient Assistance Program (PAP) is based on our commitment
to people living with diabetes and on our philosophy, known as the Novo Nordisk
Triple Bottom Line. The Diabetes PAP provides free medicine to those who
If you are approved, a free 90-day supply of medicine is sent to the prescribing
health care provider's office. Once we have your prescription, your doctor will
receive a reorder reminder from Novo Nordisk every 3 months. After your doctor places
a reorder, your medicine will be sent to your doctor’s office.
Do you qualify for PAP?
You qualify if:
- You are a US citizen or legal resident
- Your total household income is at or below 200% of the federal poverty level (FPL).
See the chart on the PAP Application (in English or Spanish) or visit the
Families USA Web site, which lists the 2013 FPL guidelines.
You are not eligible if you have:
- Any private prescription coverage, such as an HMO or PPO
- Any federal, state, or local program, such as Medicare or Medicaid. Exceptions include
patients who have entered the coverage gap (donut hole) in
Medicare Part D, and patients who have applied for and been denied Medicare Extra
Help/Low Income Subsidy (LIS) and are Medicare eligible
- Department of Veterans Affairs prescription benefits
Simple steps for a free 90-day supply of medicine
If you qualify for PAP, please follow these easy steps:
- Download the Application (in English or Spanish)
- Complete the "Applicant Information," "Patient Signature," and "Date" sections on
- Make copies of your proof of income
- Your most recent federal income tax return (Form 1040)
- Social Security Form SSA-1099
- Form W-2
- Pay stubs from the last month
- Take the application and proof of income to your doctor
Your doctor must do the following:
Please allow up to 10 business days for processing.
That’s it! Cornerstones4Care® PAP will contact your doctor directly. The medicine
you need will be sent to your doctor’s office, where you can collect it.
Download an Application Form (in English or Spanish)
Download a Refill Request Form (in English or Spanish)
covered by PAP
Novo Nordisk reserves the right to modify or cancel this program at any time without
FlexPen®, Levemir®, Novolin®, and NovoLog®NovoLog®, and Victoza® are registered trademarks
of Novo Nordisk A/S.
Bydureon™ is a trademark and Byetta® and Symlin® are
registered trademarks of Amylin Pharmaceuticals, Inc. Humalog® and
Humulin® are registered trademarks and KwikPen™ is a trademark of Eli
Lilly and Company. Apidra®, Lantus®, and SoloSTAR® are registered trademarks
of sanofi-aventis U.S. LLC.
FlexPen®, Levemir®, Novolin®, y NovoLog®NovoLog®, y Victoza® son marcas registradas
de Novo Nordisk A/S.
Bydureon™ es una marca, y Byetta® y Symlin® son marcas registradas
de Amylin Pharmaceutical, Inc. Humalog® y Humulin® son marcas registradas, y KwikPen™
es una marca de Eli Lilly and company. Apidra®, Lantus® y SoloSTAR® son marcas registradas
de sanofi-aventis U.S. LLC.