Patient Assistance Program- Diabetes Care
The Novo Nordisk 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 Novo Nordisk PAP provides free diabetes medicine
to those who qualify.
If you are approved, a free 120-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 are eligible 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 2014 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 (VA) prescription benefits
Program participants agree to verification of eligibility. Participants who are
eligible for Medicaid must provide proof of Medicaid denial.
Simple steps for a free 120-day supply of medicine
If you qualify for PAP, please follow these easy steps:
- Download the Application (in English or Spanish)
- Complete the "For Patient," "Patient Signature," and "Date" sections on the Application
- 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! After your application is reviewed, you will be informed of the decision.
Your doctor will be notified as well. If approved, your medicine will be sent to
your doctor’s office, where you can pick it up.
Once we have your prescription, your doctor will receive a reorder reminder every
3 months. After your doctor places a reorder, your medicine will be sent to your
A new application must be submitted for each new product request.
You can renew each year for as long as you qualify. Your renewal is valid for 12
Download an Application Form (in English or Spanish)
Download a Refill Request Form (in English or Spanish)
View products 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
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
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.