My$99Insulin 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    
  • Insulin Aspart Injection 100 U/mL
  • Insulin Aspart Protamine and Insulin Aspart Injectable Suspension 100 U/mL

Terms and conditions:

  • In order to redeem this card, patient must have a valid prescription for a covered insulin. 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. Medicare Part D beneficiaries must agree to obtain their Covered Insulins subject to this offer throughout the entire applicable Part D coverage year, if Part D coverage would otherwise be available. 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. The offer may be used once per calendar year. 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. Availability of the offer in Massachusetts is dependent upon state law in effect at the time patient presents the offer when paying for the covered medications. Void where taxed, restricted, or prohibited by law. This offer is not transferable and is limited to one offer per person. Not valid if reproduced.
  • This savings offer cannot be combined with any coupon, certificate, voucher, or similar offer.
  • By activating this offer, patient represents and warrants that he or she has not submitted, and will not submit, a claim for reimbursement to any payer or prescription insurance plan, including any government program, for this prescription. Patient is responsible for complying with any insurance carrier 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 1-888-910-0632.    


When you apply this offer, you are certifying that you have not submitted a claim for reimbursement to any payer or prescription insurance plan, including 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:

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

Submit each claim to SS&C Health using BIN 019158. A valid Other Coverage Code (eg, 0 or 1) is required. The patient is responsible for the first $99 per 35 mL of any combination of covered insulins and reimbursement will be received from SS&C Health.

Patient will pay $99 per 35 mL (ie, up to 3 vials or 2 packs of pens or any combination thereof) up to a maximum of 150 mL per calendar month. Once enrolled in the program, the Savings Offer is valid for the calendar year.

For any 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. US20NC00052  October 2020