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

COVID-19 job-loss exceptions:

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

Documentation required:

  • Completed PAP application
  • Documentation showing loss of healthcare benefits (job termination notice, job status change, proof that 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 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/US 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)

 

PAP Application Form (Spanish)

 

© 2020 Novo Nordisk  All rights reserved. US20NC00030  April 2020