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Terms and conditions of use

Standard Savings Offer

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. 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. 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 most recent version, please visit this webpage. Re-confirmation of patient information may be requested periodically to ensure accuracy of data and compliance with terms. Patients with questions about the Savings Offer may call 1-888-793-1218.

This offer is valid only 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 non-insurance 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 may be combined with a manufacturer sponsored automatic eVoucher offer (at participating pharmacies) but cannot be combined with any other coupon, certificate, voucher, or similar offer. 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 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:

(a) Wegovy® (semaglutide) injection 2.4 mg:

  • If you activated your savings offer, on or prior to December 31, 2021, and have a group number of AC20029011, AC20029013, or AC20029014
    • For patients with Commercial Insurance and have coverage for Wegovy®, including those within their deductible phase: As of January 3, 2023 (“Effective Date”) Pay as little as (“PALA”) $0 for up to twelve (12) 28-day fills (1 Box) of Wegovy®, subject to a maximum savings of $225 per 28-day supply (1 Box) (“Savings Benefit”), $450 per 56-day supply (2 boxes), or $675 per 84-day supply (3 boxes). Offer will be available up to and including 12/31/23. After the patient’s twelfth (12th) 28-day fill patients may then pay as little as (“PALA”) $25 per 28-day supply (1 box), $50 per 56-day supply (2 boxes), or $75 per 84-day supply (3 boxes) of Wegovy®. Subject to a maximum savings of $200 per 28-day supply (1 box), $400 per 56-day supply (2 boxes), or $600 per 84-day supply (3 boxes) of Wegovy®.
    • For patients with commercial insurance who do not have coverage for Wegovy® through their plan, or those that are cash-paying (which cannot be government beneficiaries): Save up to $500 per 28-day supply (1 box), $1,000 per 56-day supply (2 boxes), or $1,500 per 84-day supply (3 boxes) of Wegovy®.
  • If you enrolled for your Savings Offer, after January 1, 2022 or have a group number other than the ones listed in the first bullet:
    • For patients with Commercial Insurance and have coverage for Wegovy®, including those within their deductible phase: As of January 3, 2023 (“Effective Date”) Pay as little as (“PALA”) $0 for up to twelve (12) 28-day fills (1 Box) of Wegovy®, subject to a maximum savings of $225 per 28-day supply (1 Box) (“Savings Benefit”), $450 per 56-day supply (2 boxes), or $675 per 84-day supply (3 boxes). Offer will be available up to and including 12/31/23. After the patient’s twelfth (12th) 28-day fill patients may then pay as little as (“PALA”) $25 per 28-day supply (1 box), $50 per 56-day supply (2 boxes), or $75 per 84-day supply (3 boxes) of Wegovy®. Subject to a maximum savings of $200 per 28-day supply (1 box), $400 per 56-day supply (2 boxes), or $600 per 84-day supply (3 boxes) of Wegovy®.
    • For patients with commercial insurance who do not have coverage for Wegovy® through their plan, or those that are cash-paying (which cannot be government beneficiaries): Save up to $500 per 28-day supply (1 box), $1,000 per 56-day supply (2 boxes), or $1,500 per 84-day supply (3 boxes) of Wegovy®.

Patients redeeming this offer are eligible for additional savings if they are prescribed a dose de-escalation within 21 days after the date of fill for the original dose by their health care provider necessitating them to fill an injection with a lower dosage strength for Wegovy®.

(b) Saxenda® (liraglutide) injection 3 mg:

  1. For patients with Commercial Insurance and have coverage for Saxenda®, including those within their deductible phase: Pay as little as (“PALA”) $25 per 30-day supply (1 box), $50 per 60-day supply (2 boxes), or $75 per 90-day supply (3 boxes) of Saxenda®. Subject to a maximum savings of $200 per 30-day supply (1 box) (“Savings Benefit”), $400 per 60-day supply (2 boxes), or $600 per 90-day supply (3 boxes) of Saxenda®. The patient must activate this offer and the first use must occur by June 30, 2023. Offer expires December 31, 2023.
  2. For patients with commercial insurance who do not have drug coverage for Saxenda® through their plan or those that are cash-paying (which cannot be government beneficiaries): Save up to $200 per 30-day supply (1 box), $400 per 60-day supply (2 boxes), or $600 per 90-day supply (3 boxes) of Saxenda®. The patient must activate this offer and the first use must occur by June 30, 2023. Offer expires December 31, 2023.

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 commercially insured patients with product coverage:  Submit the claim to the patient’s primary insurance first, then submit the balance due to SS&C Health as a Secondary Payer as a copay only billing using BIN 019158 and a valid Other Coverage Code 08. The patient is responsible initially for the PALA amount and the offer pays up to the Savings Benefit.  Reimbursement will be received from SS&C Health.
  • For commercially Insured – not covered patients: If Wegovy® or Saxenda® is not covered by the patient’s insurance, continue to process the savings offer as a Secondary Payer to BIN 019158 along with the patient’s insurance using other coverage code 03. The patient pay amount submitted will be reduced by up to the Savings Benefit and reimbursement will be received from SS&C Health. 
  • For Cash-paying Patients (which cannot be government beneficiaries): Submit the claim to SS&C Health using BIN 019158. A valid Other Coverage Code 01 is required.  The patient pay amount submitted will be reduced by up to the Savings Benefit and reimbursement will be received from SS&C Health. 
  • For any questions regarding SS&C online processing, please call the Pharmacy Help Desk at 1-844-373-0987.
NovoCare_Wegovy_v01

Important Safety Information for Wegovy®

What is the most important information I should know about Wegovy®?

Wegovy® may cause serious side effects, including:

  • Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Wegovy® and medicines that work like Wegovy® caused thyroid tumors, including thyroid cancer. It is not known if Wegovy® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people
  • Do not use Wegovy® if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)

What is Wegovy®?

Wegovy® (semaglutide) injection 2.4 mg is an injectable prescription medicine that may help adults and children aged ≥12 years with obesity (BMI ≥30 for adults, BMI ≥ 95th percentile for age and sex for children), or some adults with excess weight (BMI ≥27) (overweight) who also have weight-related medical problems to help them lose weight and keep it off. Wegovy® should be used with a reduced calorie meal plan and increased physical activity

  • Wegovy® contains semaglutide and should not be used with other semaglutide-containing products or other GLP-1 receptor agonist medicines
  • It is not known if Wegovy® is safe and effective when taken with other prescription, over-the-counter, or herbal weight loss products
  • It is not known if Wegovy® can be used safely in people with a history of pancreatitis
  • It is not known if Wegovy® is safe and effective for use in children under 12 years of age

Important Safety Information

What is the most important information I should know about Wegovy®?

Do not use Wegovy® if:

  • you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
  • you have had a serious allergic reaction to semaglutide or any of the ingredients in Wegovy®

Before using Wegovy®, tell your healthcare provider if you have any other medical conditions, including if you:

  • have or have had problems with your pancreas or kidneys
  • have type 2 diabetes and a history of diabetic retinopathy
  • have or have had depression, suicidal thoughts, or mental health issues
  • are pregnant or plan to become pregnant. Wegovy® may harm your unborn baby. You should stop using Wegovy® 2 months before you plan to become pregnant
  • are breastfeeding or plan to breastfeed. It is not known if Wegovy® passes into your breast milk

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Wegovy® may affect the way some medicines work and some medicines may affect the way Wegovy® works. Tell your healthcare provider if you are taking other medicines to treat diabetes, including sulfonylureas or insulin. Wegovy® slows stomach emptying and can affect medicines that need to pass through the stomach quickly.

What are the possible side effects of Wegovy®?

Wegovy® may cause serious side effects, including:

  • inflammation of your pancreas (pancreatitis). Stop using Wegovy® and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back
  • gallbladder problems. Wegovy® may cause gallbladder problems, including gallstones. Some gallstones may need surgery. Call your healthcare provider if you have symptoms, such as pain in your upper stomach (abdomen), fever, yellowing of the skin or eyes (jaundice), or clay-colored stools
  • increased risk of low blood sugar (hypoglycemia) in patients with type 2 diabetes, especially those who also take medicines for type 2 diabetes such as sulfonylureas or insulin. This can be both a serious and common side effect. Talk to your healthcare provider about how to recognize and treat low blood sugar and check your blood sugar before you start and while you take Wegovy®. Signs and symptoms of low blood sugar may include dizziness or light-headedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, or feeling jittery
  • kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration
  • serious allergic reactions. Stop using Wegovy® and get medical help right away, if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat
  • change in vision in people with type 2 diabetes. Tell your healthcare provider if you have changes in vision during treatment with Wegovy®
  • increased heart rate. Wegovy® can increase your heart rate while you are at rest. Tell your healthcare provider if you feel your heart racing or pounding in your chest and it lasts for several minutes
  • depression or thoughts of suicide. You should pay attention to any mental changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you

The most common side effects of Wegovy® may include: nausea, diarrhea, vomiting, constipation, stomach (abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, heartburn, and runny nose or sore throat.

Please see Prescribing Information and Medication Guide for Wegovy®.

Wegovy® 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_Saxenda_v01

Important Safety Information for Saxenda®

Do not share your Saxenda® pen with others even if the needle has been changed. You may give other people a serious infection or get a serious infection from them.

What is the most important information I should know about Saxenda®?

Serious side effects may happen in people who take Saxenda®, including:

  • Possible thyroid tumors, including cancer. Tell your health care professional if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rats and mice, Saxenda® and medicines that work like Saxenda® caused thyroid tumors, including thyroid cancer. It is not known if Saxenda® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.
  • Do not use Saxenda® if you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

What is Saxenda®?

Saxenda® (liraglutide) injection 3 mg is an injectable prescription medicine used for adults with excess weight (BMI ≥27) who also have weight-related medical problems or obesity (BMI ≥30), and children aged 12-17 years with a body weight above 132 pounds (60 kg) and obesity to help them lose weight and keep the weight off. Saxenda® should be used with a reduced calorie diet and increased physical activity.

  • Saxenda® and Victoza® have the same active ingredient, liraglutide, and should not be used together or with other GLP-1 receptor agonist medicines
  • It is not known if Saxenda® is safe and effective when taken with other prescription, over-the-counter medicines, or herbal weight-loss products
  • It is not known if Saxenda® is safe and effective in children under 12 years of age
  • It is not known if Saxenda® is safe and effective in children aged 12 to 17 years with type 2 diabetes

Important Safety Information

Who should not use Saxenda®?

Do not use Saxenda® if:

  • you or any of your family have ever had MTC or if you have MEN 2
  • you have had a serious allergic reaction to liraglutide or any of the ingredients in Saxenda®. See symptoms of serious allergic reactions in “What are the possible side effects of Saxenda®?”
  • you are pregnant or plan to become pregnant. Saxenda® may harm your unborn baby

Before taking Saxenda®, tell your health care provider about all of your medical conditions, including if you:

  • are taking certain medicines called GLP-1 receptor agonists
  • have severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis) or problems with digesting food
  • have or have had problems with your pancreas, kidneys or liver
  • have or have had depression or suicidal thoughts, or mental health issues
  • are breastfeeding or plan to breastfeed. It is not known if Saxenda® passes into your breast milk. You and your health care provider should decide if you will use Saxenda® or breastfeed

Tell your health care provider about all the medicines you take, including prescription, over-the-counter medicines, vitamins, and herbal supplements. Saxenda® slows stomach emptying and can affect medicines that need to pass through the stomach quickly. Saxenda® may affect the way some medicines work and some other medicines may affect the way Saxenda® works. Tell your health care provider if you take diabetes medicines, especially insulin and sulfonylurea medicines.

How should I use Saxenda®?

  • Read the Instructions for Use that comes with Saxenda®
  • Inject your dose of Saxenda® under the skin (subcutaneously) in your stomach area (abdomen), upper leg (thigh), or upper arm, as instructed by your health care provider. Do not inject into a vein or muscle
  • Change (rotate) your injection site within the area you choose with each injection to reduce your risk of getting lumps under the skin (cutaneous amyloidosis). Do not use the same site for each injection

What are the possible side effects of Saxenda®?

Saxenda® may cause serious side effects, including:

  • inflammation of the pancreas (pancreatitis). Stop using Saxenda® and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your stomach area (abdomen) to your back
  • gallbladder problems. Saxenda® may cause gallbladder problems, including gallstones. Some gallbladder problems need surgery. Call your health care provider if you have any of the following symptoms: pain in your upper stomach (abdomen), fever, yellowing of your skin or eyes (jaundice), or clay-colored stools
  • increased risk of low blood sugar (hypoglycemia) in adults with type 2 diabetes who also take medicines to treat type 2 diabetes such as sulfonylureas or insulin
  • risk of low blood sugar (hypoglycemia) in children who are 12 years of age and older without type 2 diabetes
  • Signs and symptoms of low blood sugar may include: shakiness, sweating, headache, drowsiness, weakness, dizziness, confusion, irritability, hunger, fast heartbeat, and feeling jittery. You should check your blood sugar before you start taking Saxenda® and while you take Saxenda®
  • increased heart rate. Saxenda® can increase your heart rate while you are at rest. Your health care provider should check your heart rate while you take Saxenda®. Tell your health care professional if you feel your heart racing or pounding in your chest and it lasts for several minutes
  • kidney problems (kidney failure). Saxenda® may cause nausea, vomiting, or diarrhea leading to loss of fluids (dehydration). Dehydration may cause kidney failure, which can lead to the need for dialysis. This can happen in people who have never had kidney problems before. Drinking plenty of fluids may reduce your chance of dehydration. Call your health care provider right away if you have nausea, vomiting, or diarrhea that does not go away, or if you cannot drink liquids by mouth
  • serious allergic reactions. Stop using Saxenda® and get medical help right away if you have any symptoms of a serious allergic reaction including swelling of your face, lips, tongue, or throat, fainting or feeling dizzy, very rapid heartbeat, problems breathing or swallowing, or severe rash or itching
  • depression or thoughts of suicide. You should pay attention to any mental changes, especially sudden changes, in your mood, behaviors, thoughts, or feelings. Call your health care provider right away if you have any mental changes that are new, worse, or worry you

The most common side effects of Saxenda® in adults include nausea, diarrhea, constipation, vomiting, injection site reaction, low blood sugar (hypoglycemia), headache, tiredness (fatigue), dizziness, stomach pain, and change in enzyme (lipase) levels in your blood. Additional common side effects in children are fever and gastroenteritis.

Please see Prescribing Information and Medication Guide for Saxenda®.

Saxenda® 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.