NovoPen Echo® Savings Offer 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. Patient must be enrolled in a commercial insurance plan. Offer excludes full cash-paying patients. By using this offer, you are certifying that you meet the eligibility criteria and 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 complete and 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 offer may call 1-888-910-1264.
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 offer in Massachusetts will be dependent upon state law in effect at the time patient presents the offer when paying for the covered medications. Void where taxed, restricted, or prohibited by law. 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 under this offer. If the patient is eligible for drug benefits under any program other than a commercial insurance plan that covers this product, the patient cannot use this offer. This savings offer cannot be combined with any coupon, certificate, voucher, or similar offer.
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 accrues to the patient. It is illegal to (or offer to) sell, purchase, or trade this offer.
This program is not health insurance. 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:
Pay as little as (“PALA”) $0 for one pen, subject to a maximum savings of $54 (“Savings Benefit”) per prescription fill.
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 using BIN 019158 with patient responsibility amount and a valid Other Coverage Code (eg, 8). Where patient is Insured Not Covered, or a Prior Authorization (PA), Step Edit, or NDC Block is required by the Primary Payer, submit the balance due to SS&C Health as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code 3. The patient is responsible initially for the Pay As Little As 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.