Minnesota Continuing Need Insulin Safety Net Program
Eligibility Requirements:
Patient must be 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
Patient is not enrolled in Medical Assistance or MinnesotaCare
Patient (if eligible) has applied for and has been denied Medicaid and/or Medicare Extra Help/LIS
Patient’s total household income is at or below 400% of the federal poverty level (FPL)
Patient is not eligible to receive health care benefits through federally funded programs, with the exception of Medicare
Patient is not enrolled or eligible to receive prescription drug benefits through the Department of Veterans Affairs
If the patient has private prescription drug coverage, their out-of-pocket cost for a 30-day supply of insulin is greater than $75
How to apply:
Instruct patient to download and complete application
Be sure to sign and date as required
Be sure all sections are complete and accurate
Gather required documentation
Copy of proof of income
Copy of Minnesota ID
As the health care provider, complete HCP section of application, sign and date, and then fax or mail the completed application, proof of income, and proof of residency 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 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
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