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 cannot be combined with any 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 healthcare 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®. Offer expires June 30, 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®. Offer expires June 30, 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®, Saxenda®, Wegovy® and WeGoTogether® are registered trademarks of Novo Nordisk A/S.
Novo Nordisk is a registered trademark of Novo Nordisk A/S.
All other trademarks, registered or unregistered, are the property of their respective owners.
© 2023 Novo Nordisk  All rights reserved. US22NC00090 January 2023