Do not share your Ozempic® pen 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.
Diabetes Savings Offer Program
Novo Nordisk Savings Offer
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. This offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by an insurance plan or other health or pharmacy benefit programs. Medication filled prior to enrollment in this program will not be eligible for copay assistance and cannot be reimbursed. Your savings offer activation is valid for up to 48 months from date of enrollment. By using this offer, you are certifying that you meet the eligibility criteria, will comply with the terms and conditions described herein, and will not seek reimbursement for any benefit received through this offer. 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. Reconfirmation of patient information may be requested periodically to ensure accuracy of data and compliance with terms. Patients with questions about the Savings Offer may call 1‑877‑304‑6855.
This offer is valid only in the United States and its territories, unless prohibited by law, 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.
This offer is not transferable and is limited to one offer per person. Not valid if reproduced.
It is illegal to (or offer to) sell, purchase, or trade this offer.
This program is not health insurance. 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:
OZEMPIC® (semaglutide): This offer is good for eligible patients purchasing up to a 90-day supply. Patients may only participate in this program if they have been prescribed Ozempic® for an FDA-approved indication within Ozempic®’s labeling.
For patients with commercial insurance who have coverage for OZEMPIC® (semaglutide) injection 0.5 mg, 1 mg, or 2 mg: Pay as little as (“PALA”) $25, subject to a maximum savings of $100 per 1-month prescription, $200 per 2-month prescription, or $300 per 3-month prescription. Month is defined as 28 days. In order to obtain the “PALA $25 per 3-month prescription” offer, the patient must have a prescription written and dispensed for a 3-month supply, and the patient’s commercial insurance plan must provide coverage for a 3-month fill.
For patients with commercial insurance who have coverage for OZEMPIC® (semaglutide) tablets 1.5 mg, 4 mg, 9 mg: Pay as little as (“PALA”) $25, subject to a maximum savings of $100 per 1-month prescription, $200 per 2-month prescription, or $300 per 3-month prescription. Month is defined as 30 days. In order to obtain the “PALA $25 per 3-month prescription” offer, the patient must have a prescription written and dispensed for a 3-month supply, and the patient’s commercial insurance plan must provide coverage for a 3-month fill.
Commercial Copay Savings Offer Terms & Conditions:
- Patient is not eligible if he/she is enrolled in any federal or state health care program with prescription drug coverage, such as Medicaid, Medicare, VA, DOD, TRICARE, or any similar federal or state health care program (each a government program), or where prohibited by law. Note: The Federal Employees Health Benefits (FEHB) Program, Affordable Care (Health Exchange) Plans, and insurance provided through state employee plans are NOT federal or state government health care programs for purposes of this savings offer (the “Savings Offer”).
- You must meet the Ozempic® Savings Offer requirements every time you use the card.
- The Ozempic® Savings Offer is subject to a limit per monthly fill. Savings Offer benefits are set at the discretion of Novo Nordisk and may change without notice.
- 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 Offer may be combined with a manufacturer sponsored automatic eVoucher offer (at participating pharmacies) but cannot be combined with any other coupon, self-pay discount, certificate, voucher, or similar offer. This prohibited use of the savings offer extends to without limitation, any program offered through a third-party payer or pharmacy benefits manager, or an agent of either, that adjusts costs-sharing obligations. No other purchase is necessary.
- Patient is responsible for complying with any insurance carrier copayment disclosure requirements, including disclosing any savings received from this program. Novo Nordisk intends that all savings from this offer accrues to the patient and is intended to be credited towards patient out-of-pocket obligations and maximums, including applicable co-payments, coinsurance, and deductibles. Some insurance plans have established programs which require you to enroll in a manufacturer copay assistance program, including:
- Programs in which payments made by you that are subsidized by manufacturer savings offer programs, do not count towards your deductibles or other patient out-of-pocket cost sharing amounts (e.g., accumulator adjustment programs); and/or
- Programs that adjust patient out-of-pocket cost sharing amounts based on the availability of a manufacturer savings offer (e.g., maximizer programs)
If your insurer has implemented these types of programs, you will not be eligible for and agree not to use this savings program, and Novo Nordisk reserves the right to reduce or discontinue your financial assistance under this savings program, including, but not limited to, reducing your per claim maximum savings benefit and/or your annual maximum savings benefit. If you learn that your insurance company or health plan has implemented either an accumulator adjustment program or a co-pay maximizer program, you agree to not use this offer going forward, and agree to inform Novo Nordisk. Since you may be unaware whether you are subject to an accumulator adjustment or co-pay maximizer program when you enroll in the Novo Nordisk saving program, Novo Nordisk will monitor program utilization data and reserves the right to reduce, discontinue, or otherwise modify this savings offer at any time, and with or without notice.
Ozempic® Self-Pay Offer Details:
Self-pay offer for patients with insurance that does not cover Ozempic®, or those that are self-paying/opting to process outside of their insurance plan:
OZEMPIC® (semaglutide) injection 0.5 mg, 1 mg, or 2 mg:
Ozempic® Injection Self-Pay Offer Details
NDC
Description
Limited Time Offera patient price
The Limited Time Offer patient price is available to New Patients (as defined below) who meet the Limited Time Offer requirements. This offer applies to a maximum of the first two (2) 28‑day fills during the applicable offer period. Any third fill will be priced at the Standard Offerb patient price.
1-monthc
2-monthc
3-monthc
00169-4181-13
Ozempic® - 0.25 mg or 0.5 mg doses, 1 pen - 3 mL
$199.00
NA
NA
NDC
Description
Standard Offerb patient price
1-monthc
2-monthc
3-monthc
00169-4181-13
Ozempic® - 0.25 mg or 0.5 mg doses, 1 pen - 3 mL
$349.00
$698.00
$1,047.00
00169-4130-13
Ozempic® - 1 mg doses, 1 pen
$349.00
$698.00
$1,047.00
00169-4772-12
Ozempic® - 2 mg doses, 1 pen
$499.00
$998.00
$1,497.00
Limited Time Offera patient price
The Limited Time Offer patient price is available to New Patients (as defined below) who meet the Limited Time Offer requirements. This offer applies to a maximum of the first two (2) 28‑day fills during the applicable offer period. Any third fill will be priced at the Standard Offerb patient price.
NDC
00169-4181-13
Description
Ozempic® - 0.25 mg or 0.5 mg doses, 1 pen - 3 mL
| 1-monthc | 2-monthc | 3-monthc |
| $199.00 | NA | NA |
Standard Offerb patient price
NDC
00169-4181-13
Description
Ozempic® - 0.25 mg or 0.5 mg doses, 1 pen - 3 mL
| 1-monthc | 2-monthc | 3-monthc |
| $349.00 | $698.00 | $1,047.00 |
NDC
00169-4130-13
Description
Ozempic® - 1 mg doses, 1 pen
| 1-monthc | 2-monthc | 3-monthc |
| $349.00 | $698.00 | $1,047.00 |
NDC
00169-4772-12
Description
Ozempic® - 2 mg doses, 1 pen
| 1-monthc | 2-monthc | 3-monthc |
| $499.00 | $998.00 | $1,497.00 |
aLimited Time Offer Requirements:
New Patients – For purposes of the limited time offer a “New Patient” shall mean a patient new to the Ozempic® Savings Offer who has not participated in any other prior Ozempic® savings offers in the past 365 days.
For Ozempic® Injection- Eligible Patients can use the limited time offer so long as the offer is redeemed and your prescription is filled by 6/30/2026. This limited time offer is for the first 2 (two) monthly fills, with the Third Fill reverting back the Standard offer price .
bStandard Offer:
Standard offer pricing applies to patients who are not eligible for the Limited Time Offer.
cFor Ozempic® Injection, a “1-Month” fill shall refer to 1 box of 1 Ozempic® Pen, “2-Month” fill shall refer to 2 boxes of 1 Ozempic® Pen, and a “3-Month” fill shall refer to 3 boxes of 1 Ozempic® Pen.
OZEMPIC® (semaglutide) tablets 1.5 mg, 4 mg, 9 mg:
Ozempic® Tablets Self-Pay Offer Details
NDC
Description
Standard Offer patient price
1-monthd
2-monthd
3-monthd
00169-1715-30
Ozempic® 1.5 mg
30 tablets bottle
$149.00
$298.00
$447.00
00169-1704-15
Ozempic® 4 mg
30 tablets bottle
$199.00
$398.00
$597.00
00169-1709-30
Ozempic® 9 mg
30 tablets bottle
$299.00
$598.00
$897.00
Standard Offer patient price
NDC
00169-1715-30
Description
Ozempic® 1.5 mg 30 tablets bottle
| 1-monthd | 2-monthd | 3-monthd |
| $149.00 | $298.00 | $447.00 |
NDC
00169-1704-15
Description
Ozempic® 4 mg 30 tablets bottle
| 1-monthd | 2-monthd | 3-monthd |
| $199.00 | $398.00 | $597.00 |
NDC
00169-1709-30
Description
Ozempic® 9 mg 30 tablets bottle
| 1-monthd | 2-monthd | 3-monthd |
| $299.00 | $598.00 | $897.00 |
dFor Ozempic® tablets, a “1-Month” fill shall refer to 1 bottle of 30 tablets equivalent to a 30-Day Supply, a “2-Month” fill shall refer to 2 bottles of 30 tablets equivalent to a 60-Day Supply, and a “3-Month” fill shall refer to 3 bottles of 30 tablets equivalent to a 90-Day Supply.
Self-Pay Offer Terms and Conditions:
- You must meet the requirements of the Ozempic® self-pay offer every time you use this offer.
- This offer operates outside of any third-party insurance and is not valid for prescriptions covered or submitted for reimbursement, in whole or in part, under Medicare, VA, DoD, Tricare, or similar federal or state programs, including any state pharmaceutical assistance program or commercial / private insurance.
- You (and anyone else acting on your behalf) agree not to seek payment or accept reimbursement for any out-of-pocket costs for Ozempic® purchased with this offer from any insurance, including commercial insurance or any state, federal, or government healthcare programs (examples include but are not limited to Medicare, VA, DOD, TRICARE, Medicaid), healthcare reimbursement account, or any other third party payer, and you will not apply those costs toward any deductible or true out-of-pocket requirements.
- If you have Medicare, Medicare Part D, a Medicare Advantage Prescription drug plan, or any other state or federal health insurance plan, you agree to the following:
- You will not ask your insurance to pay you back for the money that you self-paid for your medication using this offer.
- You will not attempt to count the cost of this medicine toward your insurance deductible or out-of-pocket limit.
- If you are asked by your insurance company about this prescription, you will tell your insurance company that you bought this medicine outside of its prescription plan using the Ozempic® self-pay offer and that you are not seeking reimbursement or submitting a claim for this prescription.
- The purchase of the prescription under this program is not conditioned on current or any future purchases of Ozempic® or any other items or services that could become billable to any Government Program.
- If your insurance plan participates in an alternate funding program or similar arrangement (“AFP”) that requires you to apply for the Ozempic® Self-Pay Offer or seek coverage through an alternate funding vendor as a condition of covering Ozempic®, you are not eligible to use the Ozempic® Savings Offer. AFPs are programs in which coverage, reimbursement, or out-of-pocket costs are tied to the availability of manufacturer copay programs or other financial assistance programs, and may delay, deny, limit, or withhold coverage, or exclude products unless a patient uses the Ozempic® Self-Pay Offer. You agree to notify the Ozempic® Savings Offer Program if you are, or become, enrolled in such a program. Novo Nordisk reserves the right, at its sole discretion and with or without notice, to reduce, modify, or discontinue offer savings at any time, including if your commercial insurance no longer covers Ozempic® or requires use of the offer. You must meet all eligibility requirements, terms, and conditions each time you use the offer.
RYBELSUS® (semaglutide) tablets 7 mg or 14 mg: This offer is good for eligible patients purchasing up to a 3-month prescription of RYBELSUS® 7 mg or 14 mg. RYBELSUS® 3 mg is limited to up to a 1-month prescription (30-day supply) per Savings Offer redemption.
- For commercially insured patients with RYBELSUS® coverage prescribed RYBELSUS® 3 mg: Effective January 2, 2026, you may pay as little as (“PALA”) $25, subject to a maximum savings of $100 for each 1-month prescription. One month is defined as 30 days. This strength is limited to a 1-month prescription per Savings Offer redemption. Offer excludes full cash-paying patients.
- For commercially insured patients with RYBELSUS® coverage prescribed RYBELSUS® 7 mg or 14 mg: Effective January 2, 2026, you may pay as little as (“PALA”) $25, subject to a maximum savings of $100 per 1-month prescription, $200 per 2-month prescription, or $300 per 3-month prescription. One month is defined as 30 days. In order to obtain the “PALA $25 per 3-month prescription” offer, the patient must have a prescription written and dispensed for a 3-month supply, and the patient’s commercial insurance plan must provide coverage for a 3-month fill. Offer excludes full cash-paying patients.
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 offer. By applying this offer, you agree that patients enrolled in a federal or state health care program may not use this program, even if they elect to be processed as an uninsured (self-paying) patient. You also certify that you will not seek reimbursement for any benefit received through this offer.
Pharmacist instructions for Ozempic®:
- For commercially insured patients with product coverage: Submit the claim to the patient's primary insurance first, then submit the remaining out-of-pocket balance to SS&C Health as the secondary payer using the BIN/PCN/GRP/ID found on the savings offer and with an other coverage code 08. After applying the Savings Offer, collect the remaining out-of-pocket cost from the patient as shown on the adjudicated claim. Pharmacy reimbursement will be received from SS&C Health.
- For commercially insured–not covered patients: If Ozempic® is not covered by the patient’s insurance, leave the primary claim as rejected and submit to SS&C Health as secondary payer using the BIN/PCN/GRP/ID found on the Savings Offer and with an other coverage code 03. Collect the reduced out-of-pocket amount from the patient as shown on the adjudicated claim. Pharmacy reimbursement will be received from SS&C Health.
- For patients self-paying/opting to process outside of their insurance plan: Submit to SS&C Health as the primary claim using the BIN/PCN/GRP/ID found on the Savings Offer and with an other coverage code 00 or 01. Collect the reduced out-of-pocket amount from the patient shown on the adjudicated claim. Pharmacy reimbursement will be received from SS&C Health.
- Please advise each eligible Medicare Part D or other applicable Government insured patient using the self-pay offer that they must not submit the purchase for inclusion in any insurance benefit out-of-pocket spending calculations, such as Medicare Part D True Out-of-Pocket Costs (TrOOP).
- Pharmacy must submit claim within 180 days from the date the prescription was filled. For any questions regarding SS&C online processing, please call the Pharmacy Help Desk at 1‑844‑373‑0987.
Pharmacist instructions for RYBELSUS®:
- For commercially insured patients with product coverage: Submit the claim to the patient’s primary insurance first, then submit the balance due to SS&C Health as a Secondary Payer as a copay-only billing using BIN 019158 and a valid other coverage code 08. The patient is responsible initially for the PALA amount, and the offer pays up to the Savings Benefit. Reimbursement will be received from SS&C Health.
- Pharmacy must submit claim within 180 days from the date the prescription was filled. For any questions regarding SS&C online processing, please call the Pharmacy Help Desk at 1‑844‑373‑0987.
Mail-order prescriptions:
If you fill your prescription through a mail-order pharmacy or if you are unable to have your offer processed at the local pharmacy, reimbursement eligibility may be possible for any medication out-of-pocket costs.
- Download, print, and complete the Reimbursement Form found at NovoReimburse.com
- Mail the Reimbursement Form along with the following information:
- A copy of your Novo Nordisk Savings Offer, including the 10-digit GRP number (beginning with EC or AC) and the 11-digit ID number
- The original proof of purchase (original pharmacy receipt with patient’s name and address, pharmacy name, product name, NDC, prescription number or Rx number, date filled, quantity, and the overall price and copay/out-of-pocket expense paid)
- A legible photocopy of the front and back of your primary prescription insurance card
Mail all of the information to:
Novo Nordisk Savings Offer Claims Processing Dept.
PO Box 2355
Morristown, NJ 07962
Please allow 6-8 weeks to receive your reimbursement. Reimbursements are subject to program terms, conditions, and eligibility criteria. Requests must be received within 180 days from the date the prescription was filled. Medication filled prior to enrollment in this program will not be eligible for copay assistance and cannot be reimbursed.