Norditropin® (somatropin) injection 5 mg, 10 mg, 15 mg and 30 mg terms and conditions

NordiSure™ Co-pay Assistance Program Terms and Conditions:

Card covers costs including but not limited to co-pay/coinsurance up to $250 per month of therapy for a period of 12 months to a maximum of $3,000 per year. Offer excludes full cash-paying customers. Patients must be enrolled in a commercial insurance plan. Card may be used for a maximum of 12 Norditropin® prescription fills. Card is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs that reimburse the patient for the entire cost of his or her prescription drugs. Not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare (including Medicare Part D), or other Government funded or state programs (including any state prescription drug assistance programs and state health plans). The program cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Offer good only in the USA at participating pharmacies and cannot be redeemed at government-subsidized clinics. Void where taxed, restricted, or prohibited by law. Absent a change in Massachusetts law, effective January 1, 2020, the Savings Card will no longer be valid for residents of Massachusetts. Patient is responsible for complying with any insurance carrier co-payment disclosure requirements, including disclosing any savings received from this program. Re-confirmation of information may be requested periodically to ensure accuracy of data and compliance with terms. Participating patients must re-present their NordiSure™ Savings Card if changing pharmacies. This offer is limited to 1 card per patient. This card is not transferable. The NordiSure™ Savings Card may be used for mail order. Participating pharmacists must comply with all applicable laws and contractual or other obligations as a pharmacy provider. Participating patients and pharmacists understand and agree to comply with the terms and conditions of this offer as set forth herein. This is not an insurance program. Novo Nordisk reserves the right to rescind, revoke, or amend this offer without notice at any time. Non-medication expenses, such as ancillary supplies or administration-related costs, are not eligible. Must have a current prescription for an FDA-approved indication.

NordiSure™ Coinsurance Program Terms and Conditions:

Card covers costs including but not limited to co-pay/coinsurance to a maximum of $4000 per year of therapy. Offer excludes full cash-paying customers. Patients must be enrolled in a commercial insurance plan. Eligible patients must meet certain income requirements and have a co-pay greater than $1,500 toward which they must pay the first $75. Card may be used for a maximum of 12 Norditropin® prescription fills. Card is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs that reimburse the patient for the entire cost of his or her prescription drugs. Not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare (including Medicare Part D), or other Government funded or state programs (including any state prescription drug assistance programs). The program cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Offer good only in the USA. USA at participating pharmacies and cannot be redeemed at government-subsidized clinics. Void where taxed, restricted, or prohibited by law. Absent a change in Massachusetts law, effective January 1, 2020, the Savings Card will no longer be valid for residents of Massachusetts. Patient is responsible for complying with any insurance carrier co-payment disclosure requirements, including disclosing any savings received from this program. Re-confirmation of information may be requested periodically to ensure accuracy of data and compliance with terms. Participating patients must re-present their NordiSure™ Savings Card if changing pharmacies. This offer is limited to 1 card per patient. This card is not transferable. The NordiSure™ Savings Card may be used for mail order. Participating pharmacists must comply with all applicable laws and contractual or other obligations as a pharmacy provider. Participating patients and pharmacists understand and agree to comply with the terms and conditions of this offer as set forth herein. This is not an insurance program. Novo Nordisk reserves the right to rescind, revoke, or amend this offer without notice at any time. Non-medication expenses, such as ancillary supplies or administration-related costs, are not eligible. Must have a current prescription for an FDA-approved indication.

Norditropin® and NovoCare® are registered trademarks and Jumpstart™, NordiSure™, and QuickCheck™ are trademarks of Novo Nordisk A/S.   
Novo Nordisk is a registered trademark of Novo Nordisk A/S.
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© 2019 Novo Nordisk  All rights reserved. US19NC00039  October 2019