Immediate Supply offer terms and conditions

Covered insulins:

  • NovoLog® (insulin aspart injection) 100 U/mL
  • NovoLog® Mix 70/30 (insulin aspart protamine and insulin aspart injectable suspension) 100 U/mL
  • Levemir® (insulin detemir injection) 100 U/mL
  • Tresiba® (insulin degludec injection) 100 U/mL, 200 U/mL
  • Fiasp® (insulin aspart injection) 100 U/mL
  • Novolin® N vial (isophane insulin human suspension) 100 U/mL
  • Novolin® R vial (insulin human injection) 100 U/mL
  • Novolin® 70/30 vial (70% human insulin isophane suspension and 30% human insulin injection) 100 U/mL
  • Novolin® 70/30 FlexPen® 100 U/mL    

Terms and conditions:

  • In order to redeem this offer, patient must have a valid prescription for a covered insulin and attest to financial need. A valid Prescriber ID# is required on the prescription. Patient is not eligible where prohibited by law. This offer may not be redeemed for cash. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described herein and will not seek reimbursement for any benefit received through this savings offer. By enrolling for this card and utilizing the offer, Medicare Part D beneficiaries acknowledge and agree that Novo Nordisk may use information provided to Novo Nordisk or its partners to report information about offer enrollment to Part D plans. Medicare Part D beneficiaries further acknowledge and agree that any amounts paid in connection with this offer do not count towards TrOOP. Novo Nordisk’s Eligibility and Restrictions, and Offer Details may change from time to time without prior notice. For latest Terms and Conditions, please visit
  • This offer is valid in the United States, may be redeemed at participating retail pharmacies, and is intended for outpatient use only. Absent a change in Massachusetts law, effective January 1, 2021, the offer will no longer be valid for residents of Massachusetts. Void where taxed, restricted, or prohibited by law. This offer is not transferable and is limited to one offer per person per calendar year. Not valid if reproduced.
  • This savings offer cannot be combined with any coupon, certificate, voucher, or similar offer.
  • Patient is responsible for complying with any insurance carrier co-payment disclosure requirements, including disclosing any savings received from this program. It is illegal to (or offer to) sell, purchase, or trade this offer.
  • This program is managed by ConnectiveRx on behalf of Novo Nordisk. The parties reserve the right to rescind, revoke, or amend this offer without notice at any time. Patients with questions may call 1-888-910-0784.


When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any Government Program for this prescription, or where prohibited by law. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the eligibility criteria, and terms and conditions described herein. You also certify that you will not seek reimbursement for any benefit received through this offer or apply the benefit received to the True Out-of-Pocket (TrOOP).

Pharmacist instructions for free trial offer (for all patients regardless of insurance status):

Patient is not eligible if he/she seeks reimbursement from any payer or prescription insurance plan.

  • For reimbursement, please submit to SS&C Health using BIN 019158.
  • The free trial offer is valid for up to 35mL of any combination of covered insulins. This voucher expires 30 days from the date of registration.

For questions regarding SS&C Health online processing, please call the Pharmacy Help Desk at 1-844-373-0987.    

Fiasp®, Levemir®, NovoCare®, Novolin®, NovoLog®, and Tresiba® are registered trademarks of Novo Nordisk A/S.
Novo Nordisk is a registered trademark of Novo Nordisk A/S.
All other trademarks, registered or unregistered, are the property of their respective owners.

© 2020 Novo Nordisk  All rights reserved. US20NC00008  February 2020