Patient Assistance Program
The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to our patients. 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 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 our patients. 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 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.
See if you qualify for the PAP
Select the medication you’re interested in
Please select one product here. If you will be applying for multiple products, you will be able to do so during the application process.
Select your state
Select your program
The Urgent Need Program is meant for patients who have less than 7 days of insulin remaining. The Continuing Need Program is for all other applicants.
Learn about the application process
Patient Assistance Program eligibility requirements
To be eligible for this program, you must:
- Be a US citizen or legal resident
- Have a total household income that is at or below 400% of the federal poverty level (FPL). Visit the NeedyMeds website, which lists the current FPL guidelines
- Have no insurance or Medicare
- Not be enrolled in or qualify for any other federal, state, or government program such as Medicaid, Low Income Subsidy, or Veterans (VA) Benefits
- If you are eligible for Medicaid, you must sign the Patient Declaration section of the latest version of the PAP application stating that you are not enrolled in, plan to enroll in, or are eligible for Medicaid or Medicare Extra Help/LIS (proof of denial must be submitted if requested)
Apply for the PAP directly online
Questions
See the frequently asked questions below or call Novo Nordisk toll-free at 1‑866‑310‑7549.
Start applying online
Note: Applying online is only available in English
Before you start your application
You'll most likely need:
- Your health care provider's:
- Name
- State
- Email address
Note: Please verify your health care provider’s email address before beginning. Your health care provider will receive a copy of your application by email and must fill out certain portions to complete it.
- If you have Medicare, your insurance card(s)
Other items you may need:
- Your tax documents from the most recent year you filed taxes
- Proof of income
STEP 1: Download and fill out the application
Complete the following sections:
- Patient Information Section
- Insurance
- Income
- Medicare Part D consent (if applicable)
- Patient Declaration, Authorization, Consent to be Contacted, and Fair Credit Reporting Act (FCRA) Consent
STEP 2: 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
STEP 3: Ask your health care provider to complete the application
Take your application and proof of income to your health care provider and have them:
- Complete the Prescriber and Rx sections of the application
- 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 the 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 sign the Patient Declaration section of the latest version of the PAP application stating they are not enrolled in, plan to enroll in, or are eligible for Medicaid or Medicare Extra Help/LIS (proof of denial must be submitted if requested)
- Applications to participate in the PAP by individuals with 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
Apply for the PAP directly online
PAP Application Form (English)
PAP Application Form (Español)
Eligibility and enrollment
Patients must be a US citizen or legal resident, must have a total household income at or below 400% of the federal poverty level, and must be uninsured or have Medicare.
Uninsured patients are enrolled for 12 months. Medicare patients are enrolled for a calendar year.
No, we no longer require that Medicare Part D patients spend $1000 out of pocket to be eligible for the program.
Application process and approval
Applying online can be fast and easy. You'll go through a step-by-step process that tells you what to do next, with simple questions and answers. However, if you don't have internet access or are simply more comfortable applying by paper, this is also a great option.
Please note: If you speak Spanish, please use the paper/PDF format.
If an application is submitted with all supporting documentation and all required fields completed, it will be processed within 2 business days. Any missing or incomplete information may cause a delay.
If approved, patients will receive a letter in the mail. Also, if a patient opts in for automated phone notification on the application, they will receive an automated recorded phone message notification.
Health care providers will receive a letter via fax.
Once approved, a patient's medication should arrive at their prescriber's office within 10-14 business days.
Medication shipment
Unfortunately, we are currently not able to ship directly to patients.
Unfortunately, we are currently not able to ship directly to a pharmacy.
Change of doctor or address
Please contact us at 1-866-310-7549 so we can provide additional direction.
Please contact us at 1-866-310-7549 so we can update your records.
Please contact us at 1-866-310-7549 so we can update your records.
PAP reapplication
Yes. Patients will need to submit a new application and supporting documentation when their enrollment ends if they'd like to be considered for continued support. Patients should be sure to submit the latest version of the application, which is available on this page in the "Patient Assistance Program forms" section above.
Patients may submit a new application 30 days prior to the end of their enrollment. Medicare Part D patients may apply after October 15th of the current year to enroll for the following year.
Program updates
Medicare Part D
Individuals with Medicare Part D coverage may apply for 2023 PAP enrollment after October 15th, 2022. Please complete the latest version of the application available online or for download above. Be sure to enter the correct enrollment year when completing the Medicare Part D Enrollment Consent.
Auto refill
For added convenience and at the direction of the prescriber, the Novo Nordisk PAP now offers automatic refills for most medications.
All new applicants will be automatically enrolled. The medication will ship to the prescriber of an approved enrollee/applicant in accordance with current program guidelines with minimal involvement on behalf of the prescriber. Auto refills terminate at the end of the patient's program enrollment period. Auto refills are managed by the prescriber.
Novo Nordisk Maine State Insulin Affordability Program
To be eligible for this program, you must:
- Be a resident of Maine who is able to provide one of the following:
- Valid Maine driver’s license or permit
- Valid Maine identification card; or
- If the person who needs insulin is under the age of 18, the parent or legal guardian must provide proof of residency
- Not be enrolled in Medical Assistance or MaineCare
- Have your total household income be at or below 400% of the federal poverty level (FPL)
- Not be eligible to receive health care benefits through federally funded programs, with the exception of Medicare Part D
- Not be enrolled in or eligible to receive prescription drug benefits through the Department of Veterans Affairs
- Have an out-of-pocket cost of more than $75 for a 30-day supply of insulin if you have private prescription drug coverage, regardless of the type or amount of insulin needed
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Start the application process
STEP 1
Download and fill out the application
- Download the application
- Make sure that you've done the following:
- Signed and dated the form, as required
- Completed all sections with accuracy
STEP 2
Gather the required documents
- Make sure you have a copy of the following:
- Proof of income
- Maine ID
STEP 3
Ask your health care provider to complete the application
- Take your application, proof of income, and proof of residency to your health care provider, and have them do the following:
- Sign and date the application
- Fax the completed application and required documentation 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 to the residence listed on your application. Someone will reach out to you directly to schedule a time for the delivery.
- Take your application, proof of income, and proof of residency to your health care provider, and have them do the following:
- Sign and date the application
- Fax the completed application and required documentation 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 to the residence listed on your application. Someone will reach out to you directly to schedule a time for the delivery.
NOTE: If you are applying for both insulin and non-insulin, you can complete the general PAP application (click here) and advise your health care provider to include both medications in the Rx section.
Maine State Insulin Application
Maine State Insulin Application
Novo Nordisk Maine State Insulin Affordability Program
To be eligible for this program, you must:
- Be a resident of Maine who is able to provide one of the following:
- Valid Maine driver’s license or permit
- Valid Maine identification card; or
- If the person who needs insulin is under the age of 18, the parent or legal guardian must provide proof of residency
- Have an urgent need for insulin, meaning you have less than a 7-day supply
- Have a current prescription for insulin
- Be paying more than $75 each month for your insulin
- Not be enrolled in Medical Assistance or MaineCare
- Not have received an urgent need supply of insulin through this program within the previous 12 months
- If you are waiting for your Medical Assistance or MaineCare coverage to begin, or if you have been determined ineligible for a manufacturer’s patient assistance program by the manufacturer and are waiting for the Maine Board of Pharmacy’s decision on an appeal, you may be eligible to access a second 30-day supply
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Start the application process
How to apply
STEP 1
Complete the application
- The application is accessible through the Maine Board of Pharmacy website
STEP 2
Bring the application to your local pharmacy
- If the pharmacist approves your application, they'll dispense a 30-day supply of your prescribed insulin
- If the pharmacist approves your application, they'll dispense a 30-day supply of your prescribed insulin
If you are a pharmacist in the state of Maine, contact 1-833-538-0027
Novo Nordisk Minnesota State Insulin Affordability Program
To be eligible for this program, you must:
- Be a resident of Minnesota who is able to provide one of the following:
- Valid Minnesota driver’s license or permit
- Valid Minnesota identification card
- Valid tribal identification card from a Minnesota tribe; or
- If the person who needs insulin is under the age of 18, the parent or legal guardian must provide proof of residency
- Not be enrolled in Medical Assistance or MinnesotaCare
- Have your total household income be at or below 400% of the federal poverty level (FPL)
- Not be eligible to receive health care benefits through federally funded programs, with the exception of Medicare Part D
- Not be enrolled in or eligible to receive prescription drug benefits through the Department of Veterans Affairs
- Have an out-of-pocket cost of more than $75 for a 30-day supply of insulin if you have private prescription drug coverage
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Start the application process
STEP 1
Download and fill out the application
- Download the application
- Make sure that you've done the following:
- Signed and dated the form, as required
- Completed all sections with accuracy
STEP 2
Gather the required documents
- Make sure you have a copy of the following:
- Proof of income
- Minnesota ID
STEP 3
Ask your health care provider to complete the application
- Take your application, proof of income, and proof of residency to your health care provider, and have them do the following:
- Sign and date the application
- Fax the completed application and required documentation 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 to the residence listed on your application. Someone will reach out to you directly to schedule a time for the delivery.
- Take your application, proof of income, and proof of residency to your health care provider, and have them do the following:
- Sign and date the application
- Fax the completed application and required documentation 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 to the residence listed on your application. Someone will reach out to you directly to schedule a time for the delivery.
NOTE: If you are applying for both insulin and non-insulin, you can complete the general PAP application (click here) and advise your health care provider to include both medications in the Rx section.
Minnesota State Insulin Application
Minnesota State Insulin Application
Novo Nordisk Minnesota State Insulin Affordability Program
To be eligible for this program, you must:
- Be a resident of Minnesota
- Have an urgent need for insulin, meaning you have less than a 7-day supply
- Have a current prescription for insulin
- Be paying more than $75 each month for your insulin
- Not be enrolled in Medical Assistance or MinnesotaCare
- Not have received an urgent need supply of insulin through this program within the previous 12 months
- If you are waiting for your Medical Assistance or MinnesotaCare coverage to begin, or if you have been determined ineligible for a manufacturer’s patient assistance program by the manufacturer and are waiting for the Minnesota Board of Pharmacy’s decision on an appeal, you may be eligible to access a second 30-day supply
- If you are waiting for your Medical Assistance or MinnesotaCare coverage to begin, or if you have been determined ineligible for a manufacturer’s patient assistance program by the manufacturer and are waiting for the Minnesota Board of Pharmacy’s decision on an appeal, you may be eligible to access a second 30-day supply
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Start the application process
How to apply
STEP 1
Complete the application
- The application is accessible through the MNSure website
STEP 2
Bring the application to your local pharmacy
- If the pharmacist approves your application, they'll dispense a 30-day supply of your prescribed insulin
- If you are a pharmacist in the state of Minnesota, contact 1-833-538-0027
- If the pharmacist approves your application, they'll dispense a 30-day supply of your prescribed insulin
- If you are a pharmacist in the state of Minnesota, contact 1‑833‑538‑0027
Novo Nordisk Colorado State Insulin Affordability Program
To be eligible for this program, you must:
- Be a permanent, legal resident of Colorado
- Have a valid prescription for insulin
- Not be eligible for or enrolled in assistance provided through the “Colorado Medical Assistance Act,” Articles 4 to 6 of Title 25.5, or the Federal “Health Insurance for the Aged Act,” Title XVIII of the Federal “Social Security Act,” 42 U.S.C. sec 1395 et seq, as amended
- Not be enrolled in prescription drug coverage through an individual or group health plan that limits the total amount of cost sharing that an enrollee is required to pay for a 30-day supply of insulin, including copayments, deductibles, or coinsurance to $100 or less, regardless of the type or amount of insulin needed
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Start the application process
How to apply
Steps for you to follow
- Visit the Colorado Board of Pharmacy website to access the application and instructions
- Complete the application
If you are a pharmacist in the state of Colorado, contact 1-833-538-0027
- Visit the Colorado Board of Pharmacy website to access the application and instructions
- Complete the application
If you are a pharmacist in the state of Colorado, contact 1-833-538-0027
Novo Nordisk Colorado State Insulin Affordability Program
To be eligible for this program, you must:
- Be a resident of Colorado
- Have a valid prescription for insulin or be eligible for an emergency supply
- Have less than a 7-day supply of insulin available
- Be paying more than $100 out of pocket each month for your insulin
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Start the application process
How to apply
Steps for you to follow
- Visit the Colorado Board of Pharmacy website to access the application and instructions
- Complete the application
If you are a pharmacist in the state of Colorado, contact 1-833-538-0027
- Visit the Colorado Board of Pharmacy website to access the application and instructions
- Complete the application
If you are a pharmacist in the state of Colorado, contact 1-833-538-0027
Find helpful resources
Safe disposal program
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