Patient Assistance Program
The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to our patients. The Novo Nordisk PAP provides medication at no cost to those who qualify. There is no registration charge or monthly fee for participating.
Click here for a list of Novo Nordisk products covered by the PAP.
Patient Assistance Program
The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to our patients. The Novo Nordisk PAP provides medication at no cost to those who qualify. There is no registration charge or monthly fee for participating.
Click here for a list of our Novo Nordisk products covered by the PAP.
See if a patient qualifies for the PAP
See if you qualify for the PAP
Select the medication you’re interested in
Select the medication you’re interested in
Select your patient's medication
Select your patient's medication
Select your state
Select your state
Select your state to begin
Select your patient's state
Select your patient's state
Select your program
Select your program
Select a program
Select a program
The Urgent Need Program is meant for patients who have less than 7 days of insulin remaining. The Continuing Need Program is for all other applicants.
The Urgent Need Program is meant for patients who have less than 7 days of insulin remaining. The Continuing Need Program is for all other applicants.
To be eligible for this program, your patient must:
- Be a US citizen or legal resident
- Have a total household income that is at or below 400% of the federal poverty level (FPL). Visit the NeedyMeds website, which lists the current FPL guidelines
- Have no insurance or Medicare
- Not be enrolled in or qualify for any other federal, state, or government program such as Medicaid, Low Income Subsidy, or Veterans (VA) Benefits
- Patients who are eligible for Medicaid must sign the Patient Declaration section of the latest version of the PAP application stating they are not enrolled in, plan to enroll in, or are eligible for Medicaid or Medicare Extra Help/LIS (proof of denial must be submitted if requested)
Documentation required by patients affected by COVID-19
If you have a patient who has lost health insurance coverage because of a change in job status due to COVID-19, they may be eligible for a free 90-day supply of insulin.
Documentation required:
- Completed PAP application
- Documentation showing loss of health care benefits (job termination notice, job status change, proof of COBRA benefits being offered)
- No proof of income required
If approved, your patient will receive a free 90-day supply of insulin. Novo Nordisk will check back with them (before their 90-day enrollment ends) to determine continued eligibility. Assistance can be extended to the end of 2022 for otherwise eligible patients who have been denied Medicaid coverage.
Documentation required by patients affected by COVID-19
If you have a patient who has lost health insurance coverage because of a change in job status due to COVID-19, they may be eligible for a free 90-day supply of insulin.
Documentation required:
- Completed PAP application
- Documentation showing loss of health care benefits (job termination notice, job status change, proof of COBRA benefits being offered)
- No proof of income required
If approved, your patient will receive a free 90-day supply of insulin. Novo Nordisk will check back with them (before their 90-day enrollment ends) to determine continued eligibility. Assistance can be extended to the end of 2022 for otherwise eligible patients who have been denied Medicaid coverage.
Questions?
See the frequently asked questions below or call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
See the frequently asked questions below or call Novo Nordisk toll-free at 1‑866‑310‑7549.
Start the application process
Start the application process
PATIENT
Steps for your patient to follow
- Download the application in English or en Español
- Fill out, sign, and date the patient sections
- Make a copy of one of the following items to show adjusted gross annual household income:
- 2 most current paycheck stubs or earning statements for all working members in the household
- Last year’s federal Individual Income Tax Return (1040)
- Social Security income, pension, and other income statements
- W-2 or 1099 form
- Unemployment benefit statement
HEALTH CARE PROFESSIONAL
Steps for you to follow
- Fill out the “Prescriber Section” of the application
- Sign and date the application
- Fax the completed application and proof of income to 1‑866‑441‑4190, or mail them to Novo Nordisk Inc., PO Box 370, Somerville, NJ 08876. (Important: Faxes must be sent from your office.)
- Fill out the “Prescriber Section” of the application
- Sign and date the application
- Fax the completed application and proof of income to 1‑866‑441‑4190, or mail them to Novo Nordisk Inc., PO Box 370, Somerville, NJ 08876. (Important: Faxes must be sent from your office.)
Reminders
Do not include patient medical records with this application
- Patients who are eligible for Medicaid must sign the Patient Declaration section of the latest version of the PAP application stating they are not enrolled in, plan to enroll in, or are eligible for Medicaid or Medicare Extra Help/LIS (proof of denial must be submitted if requested)
- Applications to participate in PAP by Medicare enrollees must be submitted by November 30th of each calendar year
After the application is reviewed, you and your patient will be informed of the decision. If approved, an initial 120-day supply of medicine will be sent to your office, where your patient can pick it up. Please allow up to 10 business days for processing.
Click here for a full list of available products.
Reminders
Do not include patient medical records with this application
- Patients who are eligible for Medicaid must sign the Patient Declaration section of the latest version of the PAP application stating they are not enrolled in, plan to enroll in, or are eligible for Medicaid or Medicare Extra Help/LIS (proof of denial must be submitted if requested)
- Applications to participate in PAP by Medicare enrollees must be submitted by November 30th of each calendar year
After the application is reviewed, you and your patient will be informed of the decision. If approved, an initial 120-day supply of medicine will be sent to your office, where your patient can pick it up. Please allow up to 10 business days for processing.
Click here for a full list of available products.
How to renew your patient's prescription
All new applicants will be automatically enrolled in auto refills. If you have a patient currently enrolled in PAP, you will receive a reorder reminder from Novo Nordisk before your patient is due for a refill. You will need to place a reorder during the calendar year for which your patient has been approved to receive medicine. Reorders can be requested by completing and submitting the Refill Request Form below or by calling Novo Nordisk toll-free at 1-866-310-7549.
Patients can renew each year for as long as they qualify. For uninsured patients, an approved application is valid for 12 months. For patients with Medicare Part D coverage, an approved application is valid for the benefit year only. Some restrictions may apply.
Novo Nordisk reserves the right to modify or cancel this program at any time without notice.
How to renew your patient's prescription
All new applicants will be automatically enrolled in auto refills. If you have a patient currently enrolled in PAP, you will receive a reorder reminder from Novo Nordisk before your patient is due for a refill. You will need to place a reorder during the calendar year for which your patient has been approved to receive medicine. Reorders can be requested by completing and submitting the Refill Request Form below or by calling Novo Nordisk toll-free at 1‑866‑310‑7549.
Patients can renew each year for as long as they qualify. For uninsured patients, an approved application is valid for 12 months. For patients with Medicare Part D coverage, an approved application is valid for the benefit year only. Some restrictions may apply.
Novo Nordisk reserves the right to modify or cancel this program at any time without notice.
All new applicants will be automatically enrolled in auto refills. If you have a patient currently enrolled in PAP, you will receive a reorder reminder from Novo Nordisk before your patient is due for a refill. You will need to place a reorder during the calendar year for which your patient has been approved to receive medicine. Reorders can be requested by completing and submitting the Refill Request Form below or by calling Novo Nordisk toll-free at 1‑866‑310‑7549.
Patients can renew each year for as long as they qualify. For uninsured patients, an approved application is valid for 12 months. For patients with Medicare Part D coverage, an approved application is valid for the benefit year only. Some restrictions may apply.
Novo Nordisk reserves the right to modify or cancel this program at any time without notice.
PAP Refill and Change Request Form (English)
PAP Refill and Change Request Form (Español)
Eligibility
Patients must be a US citizen or legal resident, must have a total household income at or below 400% of the federal poverty level, and must be uninsured or have Medicare.
No, we no longer require that Medicare Part D patients spend $1000 out of pocket to be eligible for the program.
Application process and approval
If an application is submitted with all supporting documentation and all required fields completed, it will be processed within 2 business days. Any missing or incomplete information may cause a delay.
If approved, patients will receive a letter in the mail. Also, if a patient opts in for automated phone notification on the application, they will receive an automated message.
Health care providers will receive a letter via fax.
Uninsured patients are enrolled for 12 months. Medicare patients are enrolled for a calendar year.
Your patient's medication should arrive at your office within 10-14 business days of approval.
Medication shipment and availability
Unfortunately, we are currently not able to ship directly to patients.
Unfortunately, we are currently not able to ship directly to a pharmacy.
Unfortunately, we do not currently offer the ability to schedule delivery of your patient’s medication for certain days of the week or for a specific time of the day. Our medications ship to the prescriber and, in most cases, are delivered Monday through Friday.
Please keep your latest contact information up to date with us and, as a courtesy, we will attempt to notify you prior to each shipment via fax. You can also use our automated phone system to obtain tracking information by calling 866-310-7549.
Please keep your latest contact information up to date with us and, as a courtesy, we will attempt to notify you prior to each shipment via fax. You can also use our automated phone system to obtain tracking information by calling 866-310-7549.
Although we do our best to provide timely access to most program medications, their availability and delivery are not guaranteed. For example, the medications we offer are not always available on hand for delivery 365 days of the year. We typically notify the prescriber when availability or delivery of medications may be impacted.
In certain instances, we reserve the right to adjust the quantity of medication prescribed to align with our program guidelines. For example, Medicare Part D patient enrollments expire at the conclusion of each calendar year. Therefore, approved applicants that are also enrolled with Medicare Part D may receive less than the full quantity of their prescribed medication. However, if you believe there was an error in the quantity shipped, please contact us at 866-310-7549.
In certain instances, we reserve the right to adjust the quantity of medication prescribed to align with our program guidelines. For example, Medicare Part D patient enrollments expire at the conclusion of each calendar year. Therefore, approved applicants that are also enrolled with Medicare Part D may receive less than the full quantity of their prescribed medication. However, if you believe there was an error in the quantity shipped, please contact us at 866-310-7549.
Change of doctor or address
Please contact us at 866-310-7549 so we can update your records.
Please contact us at 866-310-7549 so we can update your records.
Please contact us at 866-310-7549 so we can provide additional direction.
Please contact us at 866-310-7549 so we can provide additional direction.
Auto refill
Auto refill is currently available for new applicants only.
Please complete the latest enrollment form available in the "Patient Assistance Program forms" section above. If an application is submitted with all of the supporting documentation and all required fields completed, it will be processed within 2 business days. Any missing or incomplete information may cause a delay.
With your consent, subject to program guidelines, you will receive automatic refills of your patient's medication for the duration of their enrollment.
Minnesota residents are currently not eligible; however, we are working toward expanding this capability to Minnesota residents in the future.
Most qualify; however, some products are excluded based on certain restrictions or program guidelines. For additional information, please review the latest application or call 866-310-7549.
Most qualify; however, some products are excluded based on certain restrictions or program guidelines. For additional information, please review the latest application or call 866-310-7549.
All eligible prescribed medications will be refilled automatically once a patient has been fully qualified and deemed eligible for the program. Certain products are excluded. For a list of excluded products, please review the latest application or call 866-310-7549.
All eligible prescribed medications will be refilled automatically once a patient has been fully qualified and deemed eligible for the program. Certain products are excluded. For a list of excluded products, please review the latest application or call 866-310-7549.
Refills will be shipped in accordance with current program guidelines. We generally do our best to automatically ship additional medication approximately 30 days prior to your patient’s medication being depleted.
You will need to submit additional documentation allowing us to manage your request. Please call 866-310-7549 at your earliest convenience for additional information.
You will need to submit additional documentation allowing us to manage your request. Please call 866-310-7549 at your earliest convenience for additional information.
Please call 866-310-7549 at your earliest convenience.
Please call 866-310-7549 at your earliest convenience.
You may opt out at any time by calling 866-310-7549 or faxing your request in writing to 866-441-4190.
You may opt out at any time by calling 866-310-7549 or faxing your request in writing to 866-441-4190.
This will depend on the prescribed medication. Most ship in 120-day supply increments to adequately cover the duration of an approved enrollment.
You may opt out by calling 866-310-7549 or faxing your request in writing to 866-441-4190.
You may opt out by calling 866-310-7549 or faxing your request in writing to 866-441-4190.
Program updates
Program updates
Medicare Part D
Individuals with Medicare Part D coverage may apply for 2023 PAP enrollment after October 15th, 2022. Please ensure patients complete the latest version of the application available for download above. Be sure to enter the correct enrollment year when completing the Medicare Part D Enrollment Consent.
Auto refill
For added convenience and at the direction of the prescriber, the Novo Nordisk PAP now offers automatic refills for most medications. All new applicants will be automatically enrolled. The medication will ship to the prescriber of an approved enrollee/applicant in accordance with current program guidelines with minimal involvement on behalf of the prescriber. Auto refills terminate at the end of the patient's program enrollment period. Auto refills are managed by the prescriber. Prescribers may opt out by calling 866‑310‑7549, by faxing their request in writing to 866‑441‑4190, or by opting out on the latest application.
Medicare Part D
Individuals with Medicare Part D coverage may apply for 2023 PAP enrollment after October 15th, 2022. Please ensure patients complete the latest version of the application available for download above. Be sure to enter the correct enrollment year when completing the Medicare Part D Enrollment Consent.
Auto refill
For added convenience and at the direction of the prescriber, the Novo Nordisk PAP now offers automatic refills for most medications. All new applicants will be automatically enrolled. The medication will ship to the prescriber of an approved enrollee/applicant in accordance with current program guidelines with minimal involvement on behalf of the prescriber. Auto refills terminate at the end of the patient's program enrollment period. Auto refills are managed by the prescriber. Prescribers may opt out by calling 866‑310‑7549, by faxing their request in writing to 866‑441‑4190, or by opting out on the latest application.
For added convenience and at the direction of the prescriber, the Novo Nordisk PAP now offers automatic refills for most medications. All new applicants will be automatically enrolled. The medication will ship to the prescriber of an approved enrollee/applicant in accordance with current program guidelines with minimal involvement on behalf of the prescriber. Auto refills terminate at the end of the patient's program enrollment period. Auto refills are managed by the prescriber. Prescribers may opt out by calling 866‑310‑7549, by faxing their request in writing to 866‑441‑4190, or by opting out on the latest application.
Novo Nordisk Minnesota State Insulin Affordability Program
To be eligible for this program, your patient must:
- Be a resident of Minnesota who is able to provide one of the following:
- Valid Minnesota driver’s license or permit
- Valid Minnesota identification card
- Valid tribal identification card from a Minnesota tribe; or
- If the person who needs insulin is under the age of 18, the parent or legal guardian must provide proof of residency
- Not be enrolled in Medical Assistance or MinnesotaCare
- Have their total household income be at or below 400% of the federal poverty level (FPL)
- Not be eligible to receive health care benefits through federally funded programs, with the exception of Medicare Part D
- Not be enrolled in or eligible to receive prescription drug benefits through the Department of Veterans Affairs
- Have an out-of-pocket cost of more than $75 for a 30-day supply of insulin if they have private prescription drug coverage
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1‑866‑310‑7549.
Start the application process
Start the application process
PATIENT
Steps for your patient to follow
- Download the application
- Fill out, sign, and date the patient sections, making sure the information is complete and accurate
- Obtain a copy of their proof of income and Minnesota ID
HEALTH CARE PROFESSIONAL
Steps for you to follow
- Complete the “Prescriber Section” of the application
- Sign and date the application
- Fax the completed application and proof of income to 1‑866‑441‑4190, or mail them to Novo Nordisk Inc., PO Box 370 Somerville, NJ 08876
Patients and prescribers will be notified of the decision by mail. If approved, a 120-day supply of insulin will be shipped directly to the patient's residence as listed on the application. Someone will reach out to the patient directly to schedule a time for delivery.
- Complete the “Prescriber Section” of the application
- Sign and date the application
- Fax the completed application and proof of income to 1‑866‑441‑4190, or mail them to Novo Nordisk Inc., PO Box 370 Somerville, NJ 08876
Patients and prescribers will be notified of the decision by mail. If approved, a 120-day supply of insulin will be shipped directly to the patient's residence as listed on the application. Someone will reach out to the patient directly to schedule a time for delivery.
Minnesota State Insulin Application
Minnesota State Insulin Refill and Change Request Form
Novo Nordisk Minnesota State Insulin Affordability Program
To be eligible for this program, your patient must:
- Be a resident of Minnesota
- Have an urgent need for insulin, meaning they have less than a 7-day supply
- Have a current prescription for insulin
- Be paying more than $75 each month for their insulin
- Not be enrolled in Medical Assistance or MinnesotaCare
- Not have received an urgent need supply of insulin through this program within the previous 12 months
- If your patient is waiting for your Medical Assistance or MinnesotaCare coverage to begin, or if they have been determined ineligible for a manufacturer’s patient assistance program by the manufacturer and are waiting for the Minnesota Board of Pharmacy’s decision on an appeal, they may be eligible to access a second 30-day supply
- If your patient is waiting for your Medical Assistance or MinnesotaCare coverage to begin, or if they have been determined ineligible for a manufacturer’s patient assistance program by the manufacturer and are waiting for the Minnesota Board of Pharmacy’s decision on an appeal, they may be eligible to access a second 30-day supply
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1‑866‑310‑7549.
Start the application process
Start the application process
How to apply
Steps for your patient to follow
- Visit the MNSure website to access the application
- Complete the application
- Bring the application to their local pharmacy where, if approved, the pharmacist will dispense a 30-day supply of the patient's prescribed insulin
If you are a pharmacist in the state of Minnesota, contact 1‑833‑538‑0027
- Visit the MNSure website to access the application
- Complete the application
- Bring the application to their local pharmacy where, if approved, the pharmacist will dispense a 30-day supply of the patient's prescribed insulin
If you are a pharmacist in the state of Minnesota, contact 1‑833‑538‑0027
Novo Nordisk Maine State Insulin Affordability Program
To be eligible for this program, your patient must:
- Be a resident of Maine who is able to provide one of the following:
- Valid Maine driver’s license or permit
- Valid Maine identification card; or
- If the person who needs insulin is under the age of 18, the parent or legal guardian must provide proof of residency
- Not be enrolled in Medical Assistance or MaineCare
- Have their total household income be at or below 400% of the federal poverty level (FPL)
- Not be eligible to receive health care benefits through federally funded programs, with the exception of Medicare Part D
- Not be enrolled in or eligible to receive prescription drug benefits through the Department of Veterans Affairs
- Have an out-of-pocket cost of more than $75 for a 30-day supply of insulin if they have private prescription drug coverage, regardless of the type or amount of insulin needed
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1‑866‑310‑7549.
Start the application process
Start the application process
PATIENT
Steps for your patient to follow
- Download the application
- Fill out, sign, and date the patient sections, making sure the information is complete and accurate
- Obtain a copy of their proof of income and Maine ID
HEALTH CARE PROFESSIONAL
Steps for you to follow
- Complete the “Prescriber Section” of the application
- Sign and date the application
- Fax the completed application and proof of income to 1‑866‑441‑4190, or mail them to Novo Nordisk Inc., PO Box 370 Somerville, NJ 08876
Patients and prescribers will be notified of the decision by mail. If approved, a 120-day supply of insulin will be shipped directly to the patient's residence as listed on the application. Someone will reach out to the patient directly to schedule a time for delivery.
- Complete the “Prescriber Section” of the application
- Sign and date the application
- Fax the completed application and proof of income to 1‑866‑441‑4190, or mail them to Novo Nordisk Inc., PO Box 370 Somerville, NJ 08876
Patients and prescribers will be notified of the decision by mail. If approved, a 120-day supply of insulin will be shipped directly to the patient's residence as listed on the application. Someone will reach out to the patient directly to schedule a time for delivery.
Maine State Insulin Application
Maine State Insulin Refill and Change Request Form
Novo Nordisk Maine State Insulin Affordability Program
To be eligible for this program, your patient must:
- Be a resident of Maine who is able to provide one of the following:
- Valid Maine driver’s license or permit
- Valid Maine identification card; or
- If the person who needs insulin is under the age of 18, the parent or legal guardian must provide proof of residency
- Have an urgent need for insulin, meaning they have less than a 7-day supply
- Have a current prescription for insulin
- Be paying more than $75 each month for their insulin
- Not be enrolled in Medical Assistance or MaineCare
- Not have received an urgent need supply of insulin through this program within the previous 12 months
- If your patient is waiting for your Medical Assistance or MaineCare coverage to begin, or if they have been determined ineligible for a manufacturer’s patient assistance program by the manufacturer and are waiting for the Maine Board of Pharmacy’s decision on an appeal, they may be eligible to access a second 30-day supply
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1‑866‑310‑7549.
Start the application process
Start the application process
How to apply
Steps for your patient to follow
- Visit the Maine Board of Pharmacy website to access the application
- Complete the application
- Bring the application to their local pharmacy where, if approved, the pharmacist will dispense a 30-day supply of the patient's prescribed insulin
If you are a pharmacist in the state of Maine, contact 1‑833‑538‑0027
- Visit the Maine Board of Pharmacy website to access the application
- Complete the application
- Bring the application to their local pharmacy where, if approved, the pharmacist will dispense a 30-day supply of the patient's prescribed insulin
If you are a pharmacist in the state of Maine, contact 1‑833‑538‑0027
Novo Nordisk Colorado State Insulin Affordability Program
To be eligible for this program, your patient must:
- Be a permanent, legal resident of Colorado
- Have a valid prescription for insulin
- Not be eligible for or enrolled in assistance provided through the “Colorado Medical Assistance Act,” Articles 4 to 6 of Title 25.5, or the Federal “Health Insurance for the Aged Act,” Title XVIII of the Federal “Social Security Act,” 42 U.S.C. sec 1395 et seq, as amended
- Not be enrolled in prescription drug coverage through an individual or group health plan that limits the total amount of cost sharing that an enrollee is required to pay for a 30-day supply of insulin, including copayments, deductibles, or coinsurance to $100 or less, regardless of the type or amount of insulin needed
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1‑866‑310‑7549.
Start the application process
Start the application process
How to apply
Steps for your patient to follow
- Visit the Colorado Board of Pharmacy website to access the application and instructions
- Complete the application
If you are a pharmacist in the state of Colorado, contact 1‑833‑538‑0027
- Visit the Colorado Board of Pharmacy website to access the application and instructions
- Complete the application
If you are a pharmacist in the state of Colorado, contact 1‑833‑538‑0027
Novo Nordisk Colorado State Insulin Affordability Program
To be eligible for this program, your patient must:
- Be a resident of Colorado
- Have a valid prescription for insulin or be eligible for an emergency supply
- Have less than a 7-day supply of insulin available
- Be paying more than $100 out of pocket each month for your insulin
Questions?
Call Novo Nordisk toll-free at 1-866-310-7549.
Questions?
Call Novo Nordisk toll-free at 1‑866‑310‑7549.
Start the application process
Start the application process
How to apply
Steps for your patient to follow
- Visit the Colorado Board of Pharmacy website to access the application and instructions
- Complete the application
If you are a pharmacist in the state of Colorado, contact 1‑833‑538‑0027
- Visit the Colorado Board of Pharmacy website to access the application and instructions
- Complete the application
If you are a pharmacist in the state of Colorado, contact 1‑833‑538‑0027
Find helpful resources
Find helpful resources
Connect patients to low-cost insulin options
Learn about low-cost insulin options that may be more affordable, especially for those without insurance or with high-deductible health insurance plans.
Resources and education
Help patients discover tools and resources tailored to their needs at Cornerstones4Care.com.
Cornerstones4Care®, Fiasp®, Levemir®, NovoCare®, NovoLog®, NovoLog® Mix 70/30, Ozempic®, RYBELSUS®, Tresiba®, Victoza®, and Xultophy® 100/3.6 are registered trademarks and Macrilen™ is a trademark 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.
© 2022 Novo Nordisk All rights reserved. US22NC00032 July 2022