Minnesota Continuing Need Insulin Safety Net Program
Eligibility Requirements:
- Patient must be a resident of Minnesota and can provide one of the following:
- Valid Minnesota driver’s license
- Valid Minnesota identification card
- Valid tribal identification card from a Minnesota tribe
- If the person who needs insulin is under the age of 18, the parent or legal guardian must provide proof of residency
- Patient is not enrolled in Medical Assistance or MinnesotaCare
- Patient (if eligible) has applied for and has been denied Medicaid and/or Medicare Extra Help/LIS
- Patient’s total household income is at or below 400% of the federal poverty level (FPL)
- Patient is not eligible to receive health care benefits through federally funded programs, with the exception of Medicare
- Patient is not enrolled or eligible to receive prescription drug benefits through the Department of Veterans Affairs
- If the patient has private prescription drug coverage, their out-of-pocket cost for a 30-day supply of insulin is greater than $75
How to apply:
- Instruct patient to download and complete application
- Be sure to sign and date as required
- Be sure all sections are complete and accurate
- Gather required documentation
- Copy of proof of income
- Copy of Minnesota ID
- As the health care provider, complete HCP section of application, sign and date, and then fax or mail the completed application, proof of income, and proof of residency to 1-866-441-4190, or mail them to Novo Nordisk Inc., PO Box 370 Somerville, NJ 08876
- Patients and prescribers will be notified of the decision by mail
- If approved, a 120-day supply of insulin will be shipped directly to the patient’s residence as listed on the application. Someone will reach out to the patient directly to schedule a time for delivery