Minnesota Continuing Need Insulin Safety Net Program

Eligibility Requirements:

  • I am a resident of Minnesota and can provide one of the following:
    • Valid Minnesota driver’s license
    • Valid Minnesota identification card
    • Valid tribal identification card from a Minnesota tribe
    • If the person who needs insulin is under the age of 18, the parent or legal guardian must provide proof of residency
  • I am not enrolled in Medical Assistance or MinnesotaCare
  • I have applied for and been denied Medicaid and/or Medicare Extra Help/LIS (if eligible)
  • My total household income is at or below 400% of the federal poverty level (FPL)
  • I am not eligible to receive health care benefits through federally funded programs, with the exception of Medicare
  • I am not enrolled or eligible to receive prescription drug benefits through the Department of Veterans Affairs
  • If I have private prescription drug coverage, my out-of-pocket cost for a 30-day supply of insulin is greater than $75

How to apply:

  1. Download and complete application
    • Be sure to sign and date as required
    • Be sure all sections are complete and accurate
  2. Gather required documentation
    • Copy of proof of income
    • Copy of Minnesota ID
  3. Take application, proof of income, and proof of residency to your health care provider to complete HCP section of application
    • HCP must 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
  4. Patients and prescribers will be notified of the decision by mail
  5. If approved, a 120-day supply of insulin will be shipped directly to the patient’s residence as listed on the application. Someone will reach out to the patient directly to schedule a time for delivery

NovoCare® is a registered trademark of Novo Nordisk A/S.
Novo Nordisk is a registered trademark of Novo Nordisk A/S.
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© 2020 Novo Nordisk  All rights reserved. US20NC00066  October 2020