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 for the PAP, you qualify to receive free diabetes medicine from Novo Nordisk for up to a year.
The Novo Nordisk PAP is free. There is no registration charge or monthly fee for participating in the Novo Nordisk PAP.
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 300% of the federal poverty level (FPL). Visit the Families USA website, which lists the current 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:
2. Complete the "For Patient," "Patient Signature," and "Date" sections on the Application
3. Make copies of your proof of income
a. Your most recent federal income tax return (Form 1040)
b. Social Security Form SSA-1099
c. Form W-2
d. Pay stubs from the last month
4. Take the application and proof of income to your health care provider
Your health care provider must do the following:
1. Complete the "For Health Care Practitioner" section of your application
2. Sign and date your application
3. Fax the completed application and your proof of income to Novo Nordisk Patient Assistance at (866) 441-4190. (Important: Faxes must be sent from your health care provider’s office. PLEASE DO NOT INCLUDE MEDICAL RECORDS WITH THIS APPLICATION)
4. You can also mail the completed application, proof of income, and order information to:
Novo Nordisk Inc.
PO Box 370
Somerville, NJ 08876
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 health care provider will be notified as well. If approved, your medicine will be sent to your health care provider’s office, where you can pick it up.
NOTE: New patients approved for the Novo Nordisk PAP are eligible for insulin vials only.
An initial 120-day supply of medicine will be sent to your prescribing health care provider’s office upon program approval. After your medicine is sent to your provider’s office, your provider will receive a reorder reminder from Novo Nordisk before you are due for your next refill. After your provider places a reorder during the year for which you have been approved to receive medicine, it will be sent to your health care provider’s office.
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 months. Some restrictions may apply.
Novo Nordisk reserves the right to modify or cancel this program at any time without notice.