TRESIBA® (insulin degludec injection) 100 U/mL, 200 U/mL eligibility

Eligibility and Restrictions:

In order to redeem this offer, patient must have a valid prescription for the brand being filled. A valid Prescriber ID# is required on the prescription. Patient is not eligible if he/she participates in or seeks reimbursement or submits a claim for reimbursement to any federal or state health care program with prescription drug coverage, such as Medicaid, Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program (each a Government Program), or where prohibited by law. Patient must be enrolled in, and must seek reimbursement from or submit a claim for reimbursement to, a commercial insurance plan. Offer excludes full cash-paying patients. 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 card. Novo Nordisk’s Eligibility and Restrictions, and Offer Details may change from time to time, and for the most recent version, please visit this webpage. Re-confirmation of information may be requested periodically to ensure accuracy of data and compliance with terms. Patients with questions about the Savings Card offer may call 1-833-992-3299.

This offer is valid in the United States and may be redeemed at participating retail pharmacies. Availability of the Savings Offer in Massachusetts will be dependent upon state law in effect at the time patient presents the Savings 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.

Cash Discount Cards and other non-insurance plans are not valid as primary insurance under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. This Savings Card cannot be combined with any coupon, certificate, voucher, or similar 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.

Offer Details:

Pay as little as (“PALA”) $25 per 30-day, $50 per 60-day, or $75 per 90-day supply, subject to a maximum savings of $150 per 30-day supply, $300 per 60-day supply or $450 per 90-day supply, or pay no more than (“PNMT”) $99 depending on insurance coverage for up to 24 months from date of Savings Card Activation. If you are commercially insured with drug coverage and your insurance co-pay is less than or equal to $175, you will receive a maximum benefit of $150 per 30-day supply, $300 per 60-day supply or $450 per 90-day supply.  If you are commercially insured without drug coverage, you will pay no more than $99 per 35mL. Offer covers up to 150 mL of medication per calendar month.

Pharmacist:

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 card.

Pharmacist instructions for a patient with an Eligible Third Party:

Submit the claim to the primary Third Party Payer first, then submit the balance due to SS&C Health as a Secondary Payer as a co-pay only billing using BIN 019158 and a valid Other Coverage Code (e.g. 8). The patient is responsible initially for the PALA amount and the card pays up to the Savings Benefit. Reimbursement will be received from SS&C Health. 

Pharmacist instructions for a cash paying patient:

Submit the claim to SS&C Health using BIN 019158. A valid Other Coverage Code (e.g. 1) is required. The patient is responsible for the first $99 per 35 mL (maximum of 150 mL per calendar month) and reimbursement will be received from SS&C Health.

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


NovoCare® and Tresiba® are registered trademarks of Novo Nordisk A/S.
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© 2021 Novo Nordisk  All rights reserved. US20NC00085  January 2021