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Growth Hormone Savings Offer Program

Program 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. 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, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program (each a government program), or where prohibited by law. Patients are also ineligible for this offer if they are Medicare-eligible and enrolled in an employer-sponsored group waiver health plan (EGWP) or government-subsidized prescription drug benefit program for retirees. 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. Patient must be enrolled in a commercial insurance plan. The brand and the prescription being filled must be covered by the patient’s commercial insurance plan. Offer excludes full cash-paying patients. This offer may not be redeemed for cash. This offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by a commercial insurance plan or other commercial health or pharmacy benefit programs. Medication filled prior to enrollment in this program will not be eligible for copay assistance and cannot be reimbursed. 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 information may be requested periodically to ensure accuracy of data and compliance with terms. Patients with questions about the savings offer may call 1-866-316-2404.

This offer is valid 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.

Cash Discount Cards and other noninsurance 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 is provided solely for the benefit of the patient. This savings offer cannot be combined with any coupon, certificate, voucher, or similar offer. This includes, without limitation, any program offered through a third-party payer or pharmacy benefits manager, or an agent of either, that adjusts cost-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 accrue to the patient and are intended to be credited toward patient out-of-pocket obligations and maximums, including applicable copayments, coinsurance, and deductibles. Some insurance plans have established programs that 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 toward your deductibles or other patient out-of-pocket cost-sharing amounts (eg, accumulator adjustment programs); and/or

  • Programs that adjust patient out-of-pocket cost-sharing amounts based on the availability of a manufacturer savings offer (eg, maximizer programs) 

Except where prohibited by law, 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 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 copay maximizer program, you agree to inform Novo Nordisk. Since you may be unaware whether you are subject to an accumulator adjustment or copay maximizer program when you enroll in the Novo Nordisk savings 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.

It is illegal to (or offer to) sell, purchase, or trade this offer.

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:

Norditropin® (somatropin) injection 5 mg, 10 mg, 15 mg, 30 mg pens: Commercially insured patients with Norditropin® coverage, including those within their deductible phase, may pay as little as (“PALA”) $0 with an annual maximum cap of $1,500. The savings offer activation is valid for 48 months from the date of enrollment, and the annual maximum cap of $1,500 will reset every January 1st until program expiration. 

Sogroya® (somapecitan-beco) injection 5 mg, 10 mg, 15 mg pens: Commercially insured patients with Sogroya® coverage, including those within their deductible phase, may pay as little as (“PALA”) $0 with an annual maximum cap of $5,000. The savings offer activation is valid for 48 months from the date of enrollment, and the annual maximum cap of $5,000 will reset every January 1st until program expiration.

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.

Pharmacist instructions for a patient with an Eligible Third Party:

Submit the claim to the primary Third Party Payer first, then submit the balance due to SS&C Health as a Secondary Payer as a copay-only billing using BIN 019158 with patient responsibility amount and a valid Other Coverage Code (eg, 8). The patient is responsible initially for the PALA amount, and the offer pays up to the Savings Benefit. Offer excludes full cash-paying patients. Reimbursement will be received from SS&C Health. For any questions regarding SS&C online processing, please call the Help Desk at 1-844-373-0987.

Mail-order prescriptions:

If you fill this prescription through a mail-order pharmacy or if you are unable to have this offer processed at a local pharmacy, reimbursement eligibility may be possible for any medication out-of-pocket costs.

  1. Download, print, and complete the reimbursement form found at NovoReimburse.com
  2. Mail the reimbursement form along with the following information: 
    1. A copy of the Norditropin® or Sogroya® Savings Offer, including the 10-digit GRP number (beginning with EC or AC) and the 11-digit ID number
    2. The original proof of purchase (pharmacy receipt with patient's name and address, pharmacy name, product name, NDC number, prescription or Rx number, date filled, quantity, and the overall price and copay/out-of-pocket expense paid)
    3. A legible photocopy of the front and back of the primary prescription insurance card


    Mailing Information:
    Novo Nordisk Savings Offer Claims Processing Dept.
    PO Box 2355
    Morristown, NJ 07962

Please allow 6-8 weeks to receive the 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.

Novocare_Norditropin_v01

Important Safety Information for Norditropin®

Do not use Norditropin® if:

  • you have a critical illness caused by certain types of heart or stomach surgery, trauma or breathing (respiratory) problems
  • you are a child with Prader-Willi syndrome who is severely obese or has breathing problems including sleep apnea
  • you have cancer or other tumors
  • you are allergic to somatropin or any of the ingredients in Norditropin®
  • your healthcare provider tells you that you have certain types of eye problems caused by diabetes (diabetic retinopathy)
  • you are a child with closed bone growth plates (epiphyses)

What is Norditropin®?

Norditropin® (somatropin) injection 5 mg, 10 mg, 15 mg or 30 mg is a prescription medicine that contains human growth hormone and is used to treat:

  • children who are not growing because of low or no growth hormone
  • children who are short (in stature) and who have Noonan syndrome, Turner syndrome, or were born small (small for gestational age-SGA) and have not caught-up in growth by age 2 to 4 years
  • children who have Idiopathic Short Stature (ISS)
  • children who are not growing who have Prader-Willi syndrome (PWS)
  • adults who do not make enough growth hormone

Important Safety Information

Before taking Norditropin®, tell your healthcare provider about all of your medical conditions, including if you:

  • have had heart or stomach surgery, trauma or serious breathing (respiratory problems)
  • have had a history of problems breathing while you sleep (sleep apnea)
  • have or have had cancer or any tumor
  • have diabetes
  • are pregnant or breastfeeding, or plan to become pregnant or breastfeed

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Norditropin® may affect how other medicines work, and other medicines may affect how Norditropin® works.

How should I use Norditropin®?

  • Use Norditropin® exactly as your health care provider tells you to
  • Do not share your Norditropin® pens and needles with another person even if the needle has been changed. You may give another person an infection or get an infection from them.

What are the possible side effects of Norditropin®?

Norditropin® may cause serious side effects, including:

  • high risk of death in people who have critical illnesses because of heart or stomach surgery, trauma or serious breathing (respiratory) problems
  • high risk of sudden death in children with Prader-Willi syndrome who are severely obese or have breathing problems including sleep apnea
  • increased risk of growth of cancer or a tumor that is already present and increased risk of the return of cancer or a tumor in people who were treated with radiation to the brain or head as children and who developed low growth hormone problems. Contact the healthcare provider if you or your child start to have headaches, or have changes in behavior, changes in vision, or changes in moles, birthmarks, or the color of your skin
  • new or worsening high blood sugar (hyperglycemia) or diabetes
  • increase in pressure in the skull (intracranial hypertension). If you or your child has headaches, eye problems, nausea or vomiting, contact the healthcare provider
  • serious allergic reactions. Get medical help right away if you or your child has the following symptoms: swelling of your face, lips, mouth or tongue, trouble breathing, wheezing, severe itching, skin rashes, redness or swelling, dizziness or fainting, fast heartbeat or pounding in your chest, or sweating
  • your body holding too much fluid (fluid retention) such as swelling in the hands and feet, pain in your joints or muscles or nerve problems that cause pain, burning, or tingling in the hands, arms, legs and feet. Tell your healthcare provider if you have any of these signs or symptoms of fluid retention.
  • decrease in a hormone called cortisol. Tell your or your child’s healthcare provider if you or your child has darkening of the skin, severe fatigue, dizziness, weakness or weight loss
  • decrease in thyroid hormone levels
  • hip and knee pain or a limp in children (slipped capital femoral epiphysis)
  • worsening of pre-existing curvature of the spine (scoliosis)
  • severe and constant abdominal pain can be a sign of pancreatitis. Tell your or your child’s healthcare provider if you or your child has any new abdominal pain.
  • loss of fat and tissue weakness in the area of skin you inject
  • increase in phosphorus, alkaline phosphatase, and parathyroid hormone levels in your blood

The most common side effects of Norditropin® include:

  • injection site reactions and rashes, and headaches

Please see Prescribing Information for Norditropin®.

Norditropin® 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.

 

Novocare_Sogroya_v01

Important Safety Information for Sogroya®

Do not use Sogroya® if:

  • you have a critical illness caused by certain types of heart or stomach surgery, trauma or breathing problems
  • you have cancer or other tumors
  • you are allergic to somapacitan-beco or any of the ingredients in Sogroya®
  • your healthcare provider tells you that you have certain types of eye problems caused by diabetes
  • you are a child with closed bone growth plates
  • you are a child with Prader-Willi syndrome who is severely obese or has breathing problems including sleep apnea (briefly stopping breathing during sleep)

What is Sogroya®?

  • Sogroya® (somapacitan-beco) injection 5 mg, 10 mg or 15 mg is a prescription medicine that contains human growth hormone, the same growth hormone made by the body. 
  • It is given by injection under the skin (subcutaneous) and is used to treat adults and children 2.5 years and older who do not make enough growth hormone.

Important Safety Information

Before taking Sogroya®, tell your healthcare provider about all of your medical conditions, including if you:

  • have had heart or stomach surgery, trauma, or serious breathing problems
  • have had cancer or any tumor
  • have diabetes
  • have adrenal gland problems
  • are taking replacement therapy with glucocorticoids
  • have thyroid gland problems
  • have liver problems
  • are a child with a history of worsening of curvature of the spine (scoliosis)
  • are pregnant or plan to become pregnant. It is not known if Sogroya® will harm your unborn baby. Talk to your healthcare provider if you are pregnant or plan to become pregnant
  • are breastfeeding or plan to breastfeed. It is not known if Sogroya® passes into your breast milk. You and your healthcare provider should decide if you will take Sogroya® while you breastfeed

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Sogroya® may affect the way some medicines work, and some medicines may affect how Sogroya® works.

How should I use Sogroya®?

  • Use Sogroya® exactly as your healthcare provider tells you to
  • Use Sogroya® 1 time each week
  • If you miss a dose of Sogroya®, the missed dose can be taken within 3 days (72 hours) after the scheduled dosing day. One-time weekly dosing for the next dose can be started again on the regularly scheduled dosing day
  • If more than 3 days (72 hours) have passed, skip the missed dose, and take your next dose on the regularly scheduled dosing day
  • Sogroya® pens are for use by 1 person only
  • Do not share your Sogroya® pens and needles with another person, even if the needle has been changed. You may give another person an infection or get an infection from them

What are the possible side effects of Sogroya®?

Sogroya® may cause serious side effects, including:

  • high risk of death in people who have critical illnesses because of heart or stomach surgery, trauma, or serious breathing problems
  • increased risk of growth of cancer or a tumor that is already present and increased risk of the return of cancer or a tumor in people who were treated with radiation to the brain or head as children and who developed low growth hormone problems. You or your child’s healthcare provider will need to monitor you or your child for a return of cancer or a tumor. Contact the healthcare provider if you or your child start to have sudden changes in behavior, headaches, vision problems, or changes in moles, birthmarks, or the color of your or your child’s skin
  • new or worsening high blood sugar or diabetes. You or your child’s blood sugar may need to be monitored during treatment with Sogroya®
  • increase in pressure in the skull. If you or your child have headaches, eye problems, nausea or vomiting, contact the healthcare provider
  • serious allergic reactions. Get medical help right away if you or your child have the following symptoms: swelling of your face, lips, mouth, or tongue, trouble breathing, wheezing, severe itching, skin rashes, redness, or swelling, dizziness or fainting, fast heartbeat or pounding in your chest, sweating
  • your or your child’s body holding too much fluid (fluid retention) such as swelling in the hands and feet, pain in your or your child’s joints or muscles or nerve problems that cause pain, burning or tingling in the hands, arms, legs, and feet. Tell your or your child’s healthcare provider if you or your child have any of these signs or symptoms of fluid retention
  • decrease in a hormone called cortisol. The healthcare provider will do blood tests to check your or your child’s cortisol levels. Tell your or your child’s healthcare provider if you or your child have darkening of the skin, severe fatigue, dizziness, weakness, or weight loss
  • decrease in thyroid hormone levels. Decreased thyroid hormone levels may affect how well Sogroya® works. The healthcare provider will do blood tests to check you or your child’s thyroid hormone levels
  • severe and constant abdominal pain. This could be a sign of pancreatitis. Tell your or your child’s healthcare provider if you or your child has any new abdominal pain
  • loss of fat and tissue weakness in the area of skin you or your child inject. Talk to your or your child’s healthcare provider about rotating the areas where you or your child inject Sogroya®
  • worsening of curvature of the spine in children (scoliosis)
  • hip and knee pain or a limp in children (slipped capital femoral epiphysis)
  • high risk of sudden death in children with Prader-Willi syndrome who are severely obese or have breathing problems, including sleep apnea
  • increase in phosphorus, alkaline phosphatase, and parathyroid hormone levels in your blood. You or your child’s healthcare provider will do blood tests to check this

The most common side effects of Sogroya® in children include: common cold, headache, fever, pain in extremity, and reaction to injection

The most common side effects of Sogroya® in adults include: back pain, joint pain, indigestion, sleep problems, dizziness, swelling of the tonsils (tonsillitis), vomiting, high blood pressure, increase in the level of an enzyme in your blood called creatine phosphokinase, weight gain, and low red blood cells (anemia)

Please see Prescribing Information for Sogroya®.

Sogroya® 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.