Patient Assistance Program

The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to people living with diabetes. The Patient Assistance Program provides medication at no cost to those who qualify.

Patients who are approved for the PAP may qualify to receive free diabetes medicine from Novo Nordisk. There is no registration charge or monthly fee for participating.

Click here for a list of our Novo Nordisk products covered by the PAP.

Patient Assistance Program

The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to people living with diabetes. The Patient Assistance Program provides medication at no cost to those who qualify.

Patients who are approved for the PAP may qualify to receive free diabetes medicine from Novo Nordisk. There is no registration charge or monthly fee for participating.

Click here for a list of our Novo Nordisk products covered by the PAP.

If you have lost your health insurance coverage because of a change in job status due to COVID-19, you may be eligible for a free 90-day supply of insulin. See COVID-19 exceptions below.

See if you qualify for the PAP

Eligibility requirements:

  • I am a US citizen or legal resident
  • My total household income is at or below 400% of the federal poverty level (FPL). Visit the NeedyMeds website, which lists the current FPL guidelines
  • I have no insurance or I have Medicare
  • I am not enrolled in and don’t qualify for any other federal, state, or government program such as Medicaid, Low Income Subsidy, or Veterans (VA) Benefits
    • Exceptions include people who are Medicaid-eligible who have applied for and been denied Medicaid
  • See eligibility requirements for Minnesota residents

COVID-19 job-loss exceptions:

Application process changes if your benefits have been affected by COVID-19.

Documentation required:

  • Completed PAP application
  • Documentation showing loss of healthcare benefits (job termination notice, job status change, proof of COBRA benefits being offered)
  • No proof of income required

If approved, you will receive a free 90-day supply of insulin. Novo Nordisk will check back with you (before your 90-day enrollment ends) to determine continued eligibility. Assistance can be extended to the end of 2020 for otherwise eligible patients who have been denied Medicaid coverage.

If this exception doesn’t apply to you, see all options for saving on your Novo Nordisk insulin.

Questions?

Please call Novo Nordisk toll-free at 1-866-310-7549.

How to apply

Download and fill out the application

  • Complete the following sections:
    • Part 2: Patient Information
    • Part 3: Patient Certification and Authorization

Gather proof of income

  • Make a copy of one of the following items to show your adjusted gross annual household income:
    • 2 most current paycheck stubs or earning statements for all working members of your household
    • Last year’s federal Individual Income Tax Return (1040)
    • Social Security income, pension, and other income statements
    • W-2 or 1099 forms
    • Unemployment benefit statements

Take the application and proof of income to your health care provider

  • Your health care provider must:
    • Complete the "For Health Care Practitioner" section of the application, including “Order information” (subsection D)
    • Sign and date the application
    • Fax the completed application and proof of income to 1-866-441-4190, or mail them to Novo Nordisk Inc., PO Box 370, Somerville, NJ 08876. Faxes must be sent from your health care provider’s office

Please allow up to 10 business days for processing.

Note:

After the application is reviewed, you and your health care provider will be informed of the decision. If approved, your medicine will be sent to your health care provider’s office, where you can pick it up.

Product availability subject to change without notice.

Novo Nordisk reserves the right to modify or cancel this program at any time without notice.

Important:

  • Do not include patient medical records with this application
  • Patients who are eligible for Medicaid must complete the Medicaid Eligibility form (proof of denial must be submitted if requested at any time)
  • Patients who are eligible for Medicare Part D must provide proof of Medicaid or Extra Help/LIS denial
  • Applications to participate in PAP by Medicare must be submitted by November 30th of each calendar year and qualified Medicare patients will be enrolled in the program through December 31st of the calendar year    

Patient Assistance Program Forms

PAP Application Form (English)

 

Download now

PAP Application Form (Español)

 

Download now
All Claims (v4) Novocare

Fiasp® Selected Important Safety Information

Do not share your Fiasp® with other people, even if the needle has been changed. You may give other people a serious infection, or get a serious infection from them.

Who should not take Fiasp®?

Do not take Fiasp® if:

  • your blood sugar is too low (hypoglycemia) or you are allergic to any of its ingredients.

Before taking Fiasp® tell your health care provider about all your medical conditions including, if you:

  • have kidney or liver problems
  • are pregnant or breastfeeding or plan to become pregnant or breastfeed. It is not known if Fiasp® passes into your breast milk.
  • are taking new prescription or over-the-counter medicines, including supplements.

Talk to your health care provider about low blood sugar and how to manage it.

What is Fiasp® (insulin aspart injection) 100 U/mL?

  • Fiasp® is a man-made insulin used to control high blood sugar in adults and children with diabetes mellitus.

Fiasp® Important Safety Information

Do not share your Fiasp® with other people, even if the needle has been changed. You may give other people a serious infection, or get a serious infection from them.

Who should not take Fiasp®?

Do not take Fiasp® if:

  • your blood sugar is too low (hypoglycemia) or you are allergic to any of its ingredients.

Before taking Fiasp® tell your health care provider about all your medical conditions including, if you:

  • have kidney or liver problems
  • are pregnant or breastfeeding or plan to become pregnant or breastfeed. It is not known if Fiasp® passes into your breast milk.
  • are taking new prescription or over-the-counter medicines, including supplements.

Talk to your health care provider about low blood sugar and how to manage it.

How should I take Fiasp®?

  • Read the Instructions for Use and take Fiasp® exactly as your health care provider tells you to.
  • Fiasp® starts acting fast. You should take your dose of Fiasp® at the beginning of the meal or within 20 minutes after starting a meal.
  • Know the type and strength of your insulin. Do not change your insulin type unless your health care provider tells you to. 

Change (rotate) your injection sites within the area you choose with each injection to reduce your risk of getting pits in skin or thickened skin (lipodystrophy) and skin with lumps (localized cutaneous amyloidosis) at the injection sites.

    • Do not use the exact same spot for each injection.
    • Do not inject where the skin has pits, is thickened, or has lumps.
    • Do not inject where the skin is tender, bruised, scaly or hard, or into scars or damaged skin.
  • If you miss a dose of Fiasp® monitor your blood sugar levels to decide if an insulin dose is needed. Continue with your regular dosing schedule at the next meal.
  • Check your blood sugar levels. Ask your health care provider what your blood sugar levels should be and when you should check them.
  • Do not reuse or share your needles with other people. You may give other people a serious infection or get a serious infection from them.

What should I avoid while taking Fiasp®?

  • Do not drive or operate heavy machinery, until you know how Fiasp® affects you.
  • Do not drink alcohol or use medicines that contain alcohol.

What are the possible side effects of Fiasp®?

Serious side effects can lead to death, including:
  • Low blood sugar (hypoglycemia). Some signs and symptoms include: anxiety, irritability, mood changes, dizziness or light-headedness, sweating, confusion, and headache.
  • low potassium in your blood (hypokalemia).
  • serious allergic reactions (whole body reactions). Get emergency medical help right away if you have a rash over your whole body; trouble breathing; a fast heartbeat; swelling of your face, tongue or throat; sweating; extreme drowsiness; dizziness, or confusion.
  • heart failure. Taking certain diabetes pills called TZDs (thiazolidinediones) with Fiasp® may cause heart failure in some people. This can happen even if you have never had heart failure or heart problems before. If you already have heart failure it may get worse while you take TZDs with Fiasp®. Your health care provider should monitor you closely while you are taking TZDs with Fiasp®. Tell your health care provider if you have any new or worse symptoms of heart failure including shortness of breath, swelling of your ankles or feet, or sudden weight gain.

Your insulin dose may need to change because of:

  • weight gain or loss, increased stress, illness, or change in diet or level of physical activity

Common side effects of Fiasp® may include:

  • skin problems such as eczema, rash, itching, redness and swelling of your skin (dermatitis), reactions at the injection site such as itching, rash, skin thickening or pits at the injection site (lipodystrophy), or weight gain.

Please click here for Fiasp® Prescribing Information.

Fiasp® is a prescription medication.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

If you need assistance with prescription costs, help may be available. Visit www.pparx.org or call 1-888-4PPA-NOW.

© 2020 Novo Nordisk  All rights reserved. US20NC00066  October 2020