Terms and Conditions of Use

Novocare® (Lifefill I, LLC d/b/a Novocare®)
Novocare® Legacy (CoAssist Pharmacy d/b/a Novocare® Legacy)

Covered products:

Wegovy® (semaglutide) injection 2.4 mg

Total strength per total volume
NDC

0.25 mg/0.5 mL
00169-4525-14

0.5 mg/0.5 mL
00169-4505-14

1 mg/0.5 mL
00169-4501-14 

1.7 mg/0.75 mL
00169-4517-14

2.4 mg/0.75 mL
00169-4524-14

Eligibility and Restrictions

To participate in this Wegovy® Novocare® and Novocare® Legacy cash/self-pay program, patient must have a valid prescription for the Wegovy®. A valid Prescriber ID# is required on the prescription. 

Patients must either be uninsured or have insurance (either commercial or government-funded) but decide to self-pay. Patients may only participate in this cash/self-pay program if they have been prescribed Wegovy® for an FDA-approved indication within Wegovy®’s labeling.

Program Details

By using this program, patients must certify that he/she meets the eligibility criteria and will comply with the terms and conditions described for Eligibility and Program Details.

Patient agrees he or she will not seek reimbursement or otherwise submit a claim to any insurer (primary, secondary, commercial, employer, government nor supplemental) for any medication received through this program.

When a prescription for Wegovy® is received from a licensed prescriber, Novocare® or Novocare® Legacy will review and validate the prescription. Patients will have the option to utilize the cash/self-pay program through CenterWell Pharmacy, CoAssist Pharmacy d/b/a Novocare® Legacy, and/or Lifefill I, LLC d/b/a Novocare® (“Novocare® and Novocare® Legacy”).

Novocare® and Novocare® Legacy operate through licensed pharmacies that dispense product under a cash /self-pay model and insurance is not accepted. These cash/self-pay prescriptions are filled by Centerwell Pharmacy, CoAssist Pharmacy d/b/a Novocare® Legacy, or BlinkRx Network Pharmacies.

Novo Nordisk’s Eligibility and Restrictions, and Program 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 program may call 1‑866‑898‑9368.

This offer is not insurance. This offer is not contingent on any past, current, or future purchase of Wegovy®. This offer cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer not associated with this offer. This offer is valid only in the United States and its territories, unless prohibited by law.

The table below explains what patients enrolled in the program can pay based on which medicine they receive: 

Wegovy® (semaglutide) injection:

Wegovy® 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

00169-4525-14

Wegovy® - 0.25 mg 4 single-dose prefilled pens

$199.00

NA

NA

00169-4505-14

Wegovy® - 0.5 mg 4 single-dose prefilled pens

$199.00

NA

NA

NDC

Description

Standard Offerb patient price

1-monthc

2-monthc

3-monthC

00169-4525-14

Wegovy® - 0.25 mg 4 single-dose prefilled pens

$349.00

$698.00

$1,047.00

00169-4505-14

Wegovy® - 0.5 mg 4 single-dose prefilled pens

$349.00

$698.00

$1,047.00

00169-4501-14

Wegovy® - 1.0 mg 4 single-dose prefilled pens

$349.00

$698.00

$1,047.00

00169-4517-14

Wegovy® - 1.7 mg 4 single-dose prefilled pens

$349.00

$698.00

$1,047.00

00169-4524-14

Wegovy® - 2.4 mg 4 single-dose prefilled pens

$349.00

$698.00

$1,047.00

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
00169-4525-14

Description
Wegovy® - 0.25 mg 4 single-dose prefilled pens

1-monthc 2-monthc 3-monthc
$199.00 NA NA

NDC
00169-4505-14

Description
Wegovy® - 0.5 mg 4 single-dose prefilled pens

1-monthc 2-monthc 3-monthc
$199.00 NA NA

Standard Offerb patient price

NDC
00169-4525-14

Description
Wegovy® - 0.25 mg 4 single-dose prefilled pens

1-monthc 2-monthc 3-monthc
$349.00 $698.00 $1,047.00

NDC
00169-4505-14

Description
Wegovy® - 0.5 mg 4 single-dose prefilled pens

1-monthc 2-monthc 3-monthc
$349.00 $698.00 $1,047.00

NDC
00169-4501-14

Description
Wegovy® - 1.0 mg 4 single-dose prefilled pens

1-monthc 2-monthc 3-monthc
$349.00 $698.00 $1,047.00

NDC
00169-4517-14

Description
Wegovy® - 1.7 mg 4 single-dose prefilled pens

1-monthc 2-monthc 3-monthc
$349.00 $698.00 $1,047.00

NDC
00169-4524-14

Description
Wegovy® - 2.4 mg 4 single-dose prefilled pens

1-monthc 2-monthc 3-monthc
$349.00 $698.00 $1,047.00

aLimited Time Offer Requirements:

  • New Patients are eligible patients who have never filled a Wegovy® injection prescription through Novocare® or Novocare® Legacy.

  • For Wegovy® Injection- Eligible patients may use this Limited Time Offer if the prescription is written on or before 12/31/2026, received by the pharmacy by the end of day on 12/31/2026, and shipped on or before 1/31/2027. The Limited Time Offer applies to the first two (2) 28-day fills. The third fill will be priced at the Standard Offerb price.

bStandard Offer:

  • Standard offer pricing applies to patients who are not eligible for the Limited Time Offer.

cFor Wegovy® Injection, a “1-Month” fill  shall refer to 1 box of 4 Single-Dose Prefilled Pens equivalent to a 28-Day Supply, “2-Month” fill shall refer to 2 boxes of 4 Single-Dose Prefilled Pens equivalent to a 56-Day Supply, and a “3-Month” fill shall refer to 3 boxes of 4 Single-Dose Prefilled Pens equivalent to a 84-Day Supply.

Patient Attestation

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 Wegovy® 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 Wegovy® or any other items or services that could become billable to any government program.

Assurance of Medication Supply

This program will continue to enroll patients so long as each enrolled patient can receive a consistent supply of medication. This assurance is only applicable for those patients who remain enrolled and adherent to the treatment. Novo Nordisk reserves the right to pause or terminate enrollment to prioritize supply for those qualified.

Disclosure of Third-Party Partnerships

Lifefill I, d/b/a Novocare®: A BlinkRx-affiliated pharmacy licensed in the State of Idaho that serves as the initial prescribe-to pharmacy when you elect to use the Novocare® program for prescription services.

BlinkRx: A licensed pharmacy and digital prescription service that manages and facilitates patient intake, outreach, patient account management, payment processing, shipment tracking, and support services for the Novocare® and, for eligible patients, may facilitate transfer of a patient's prescription to a BlinkRx Network Pharmacy for dispensing.

BlinkRx Network Pharmacies: Licensed pharmacies participating in the BlinkRx network, including third-party pharmacies that are unaffiliated with BlinkRx, that dispense prescriptions to eligible patients and ship them via home delivery. The BlinkRx network includes pharmacies that, collectively, are licensed to dispense into all 50 states, the District of Columbia, and Puerto Rico.

AssistRx: A patient solutions provider responsible for Novocare® Legacy’s outreach and live support. 

CoAssist: A licensed pharmacy in all 50 US States and territories that for purposes of this program is CoAssist Pharmacy d/b/a Novocare® Legacy. CoAssist Pharmacy d/b/a Novocare® Legacy is a dispensing pharmacy responsible for patient accounts, payment collection, medication fulfillment, tracking, and shipping for the Novocare® Legacy program.

CenterWell: A Novocare® Legacy dispensing pharmacy responsible for patient accounts, payment collection, medication fulfillment, tracking, and shipping.

NovoCare_Wegovy_MASH_v01

Important Safety Information for Wegovy®

What is the most important information I should know about Wegovy®?

Wegovy® may cause serious side effects, including:

  • Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Wegovy® and medicines that work like Wegovy® caused thyroid tumors, including thyroid cancer. It is not known if Wegovy® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people
  • Do not use Wegovy® if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)

What is Wegovy®?

Wegovy® (semaglutide) injection 2.4 mg is an injectable prescription medicine used with a reduced calorie diet and increased physical activity to:

  • treat adults with metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver scarring (fibrosis), but not with cirrhosis of the liver

This indication is approved based on improvement of MASH and liver scarring. There is an ongoing study to confirm the clinical benefit of Wegovy® in adults with MASH.

  • reduce the risk of major cardiovascular events such as death, heart attack, or stroke in adults with known heart disease and with either obesity or overweight
  • help adults and children aged 12 years and older with obesity, or some adults with excess weight (overweight) who also have weight-related medical problems to lose weight and keep the weight off

Wegovy® contains semaglutide and should not be used with other semaglutide-containing products or other GLP-1 receptor agonist medicines

It is not known if Wegovy® is safe and effective:

  • for the treatment of MASH in people under 18 years of age
  • to reduce the risk of major cardiovascular events (death, heart attack, or stroke) in people under 18 years
  • to help children under 12 years of age lose weight and keep the weight off

Important Safety Information

Do not use Wegovy® if:

  • you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • you have had a serious allergic reaction to semaglutide or any of the ingredients in Wegovy®. See “What are the possible side effects of Wegovy®?” for symptoms of a serious allergic reaction.

Wegovy® FlexTouch®: Do not share your Wegovy® FlexTouch® 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.

Before using Wegovy®, tell your healthcare provider if you have any other medical conditions, including if you:

  • have or have had problems with your pancreas or kidneys
  • have type 2 diabetes and a history of diabetic retinopathy
  • are scheduled to have surgery or other procedures that use anesthesia or deep sleepiness (deep sedation)
  • are pregnant or plan to become pregnant. Wegovy® may harm your unborn baby. You should stop using Wegovy® 2 months before you plan to become pregnant
  • are breastfeeding or plan to breastfeed. It is not known if Wegovy® when received through an injection passes into your breast milk

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Wegovy® may affect the way some medicines work and some medicines may affect the way Wegovy® works. Tell your healthcare provider if you are taking other medicines to treat diabetes, including sulfonylureas or insulin. Wegovy® slows stomach emptying and can affect medicines that need to pass through the stomach quickly.

What are the possible side effects of Wegovy®?

Wegovy® may cause serious side effects, including:

  • inflammation of your pancreas (pancreatitis). Stop using Wegovy® and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without nausea or vomiting. Sometimes you may feel the pain from your abdomen to your back
  • gallbladder problems. Wegovy® may cause gallbladder problems, including gallstones. Some gallstones may need surgery. Call your healthcare provider if you have symptoms, such as pain in your upper stomach (abdomen), fever, yellowing of the skin or eyes (jaundice), or clay-colored stools
  • increased risk of low blood sugar (hypoglycemia), especially those who also take medicines for diabetes such as insulin or sulfonylureas. This can be a serious side effect. Talk to your healthcare provider about how to recognize and treat low blood sugar and check your blood sugar before you start and while you take Wegovy®. Signs and symptoms of low blood sugar may include dizziness or light-headedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, or feeling jittery
  • dehydration leading to kidney problems. Diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration) which may cause kidney problems. It is important for you to drink fluids to help reduce your chance of dehydration. Tell your healthcare provider right away if you have nausea, vomiting, or diarrhea that does not go away
  • severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use Wegovy®. Tell your healthcare provider if you have stomach problems that are severe or will not go away
  • serious allergic reactions. Stop using Wegovy® and get medical help right away, if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat
  • change in vision in people with type 2 diabetes. Tell your healthcare provider if you have changes in vision during treatment with Wegovy®
  • increased heart rate. Wegovy® can increase your heart rate while you are at rest. Tell your healthcare provider if you feel your heart racing or pounding in your chest and it lasts for several minutes
  • food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sleepiness (deep sedation). Wegovy® may increase the chance of food getting into your lungs during surgery or other procedures. Tell all your healthcare providers that you are taking Wegovy® before you are scheduled to have surgery or other procedures

The most common side effects of Wegovy® may include: nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, changes in skin sensations, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, low blood sugar in people with type 2 diabetes, gas, stomach flu, heartburn, and hair loss.

Please see Prescribing Information and Medication Guide for Wegovy®.

Wegovy® 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.

 

Please see Prescribing Information and Medication Guide for Wegovy®.

Wegovy® 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.