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 may qualify to receive free diabetes medicine from Novo Nordisk for up to a year.
Do you qualify for PAP?
You may be 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
- Department of Veterans Affairs (VA) prescription benefits
- Any federal, state, or local program such as Medicare or Medicaid. Exceptions include:
- Medicare Part D patients who have spent $1,000 on prescription medicine in the current calendar year
- Patients who have applied for and been denied Medicare Extra Help/Low Income Subsidy (LIS) and are Medicare eligible but do not have Medicare Part D coverage. To apply for LIS, please contact the Social Security Administration (SSA) at 800-772-1213 (TTY 800-325-0778) or go to www.socialsecurity.gov/prescriptionhelp
- Patients who are Medicaid eligible must have applied for and been denied Medicaid to be eligible for the Novo Nordisk PAP
Simple steps for a free 120-day supply of medicine
If you would like to find out if you qualify for PAP, please follow these 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.
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. For uninsured patients, an approved application is valid for 12 months. For patients with Medicare Part D coverage, an approved application is valid for the benefit year only. Some restrictions may apply.
Novo Nordisk reserves the right to modify or cancel this program at any time without notice.