Norditropin® (somatropin) injection 5 mg, 10 mg, 15 mg and 30 mg terms and conditions
Patient Access Program (PAP) eligibility
Patients who meet program eligibility criteria and financial need requirements are eligible to receive a free supply of Norditropin® for up to one (1) year with requalification process to occur thirty (30) days prior to PAP expiration.
- You must be a US citizen or legal resident
- Your total household income must be at or below 350% of the federal poverty level (FPL) after inclusion of Norditropin® estimated cost deduction. Visit the NeedyMeds website, which lists the current FPL guidelines
- You must have been prescribed therapy for a diagnosis that is an FDA approved indication for Norditropin®
- You cannot have or qualify for government benefit coverage, including any federal state, or local program such as Medicare or Medicaid:
- Exceptions include:
- Government beneficiary with diagnosis or therapy exclusion
- Patients who are eligible for Department of Veterans Affairs (VA) prescription benefits or Medicaid must have applied for and been denied enrollment, including exhaustion of all appeals
- Patients who are Medicare eligible and do not have Medicare Part D coverage who have applied for and been denied Extra Help/Low Income Subsidy (LIS). To apply for LIS, please contact the Social Security Administration at 1-800-722-1213 (TTY 1-800-325-0778) or go to ssa.gov/benefits/medicare/prescriptionhelp/
Patients who have been prescribed Norditropin® for an FDA-approved indication, and who have commercial insurance may be eligible to receive a limited supply of free product from JumpStart™. Patients who participate in any government, state, or federally funded medical or prescription benefit programs, including Medicare, Medicaid, Medigap, VA, DOD, and TRICARE, including patients who participate in a managed Medicaid program or have Medicaid as secondary insurance, are not eligible to participate in JumpStart™.
JumpStart™ product is provided at no cost to the patient or the HCP, is not contingent on any product purchase, and the patient and HCP must not: (1) bill any third party for the free product, or (2) resell the free product.