Patient Assistance Program

The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to people living with diabetes. 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 people living with diabetes. 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.

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. See “Documentation required” in the “See if a patient qualifies for the PAP” section below.

2021 program updates

MEDICARE PART D

Individuals with Medicare Part D coverage may apply for 2022 PAP enrollment after October 15th, 2021. Please ensure patients complete the latest version of the application available for download below. Be sure to enter the correct enrollment year when completing page 3.

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.

See if a patient qualifies for the PAP

Eligibility requirements:

  • Patient must be a US citizen or legal resident
  • Total household income must be at or below 400% of the federal poverty level (FPL). Visit the NeedyMeds website, which lists the current FPL guidelines
  • Patient has no insurance or has Medicare
  • Patient is not enrolled in and doesn't 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)
  • See eligibility requirements for Minnesota residents

Documentation required for patients affected by COVID-19:

  • Completed PAP application
  • Documentation showing loss of healthcare 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 2021 for otherwise eligible patients who have been denied Medicaid coverage.

Questions?

Please see the frequently asked questions below or call Novo Nordisk toll-free at 1‑866‑310‑7549.

Start the application process

Steps for your patient to follow:

  1. Download the application in English or en Español
  2. Complete, sign, and date the patient sections
  3. 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

Steps for you as the health care professional to follow:

  1. Complete the “For Health Care Practitioner” section of the application
  2. Sign and date the application
  3. 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 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.

PAP Application Form (English)

PAP Application Form (Español)

PAP Refill Request Form (English)

PAP Refill 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.

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.

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 provide additional direction.

Auto-refill

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.

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 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.

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.

Patients can get help with diabetes management

Help patients discover tools and resources tailored to their needs at Cornerstones4Care.com.

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Novo Nordisk is a registered trademark of Novo Nordisk A/S.
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© 2021 Novo Nordisk  All rights reserved. US21NC00011  November 2021