Resources for you and your patients

We’re committed to providing you with tools and information to support your patients with hemophilia or rare bleeding disorders. Here, you’ll find forms and programs that will help your patients get the treatment they need.

Resources for you and your patients

We’re committed to providing you with tools and information to support your patients with hemophilia or rare bleeding disorders. Here, you’ll find forms and programs that will help your patients get the treatment they need.

QuickCheck™ benefits verification

In 4 business hours or less, you can verify your patients’ benefits.a You will receive confirmation of coverage, as well as information about deductibles, copays, and/or coinsurance. If no coverage is available, names of alternative therapies may be supplied.

aQuickCheck™ benefits verification can be completed within 4 business hours only if all required information has been submitted accurately.

Statement of medical necessity

Download the appropriate statement of medical necessity and fill it out to attest your patient’s need for treatment. Once you’ve completed and submitted the form, you can expect to be contacted by a NovoCare Case Manager within 72 hours, Monday-Friday.b

bInaccurate information in your form could delay patient enrollment.

Product assistance program (PAP)

Eligible patients who do not have prescription coverage may be able to get their treatment free of charge through the Novo Nordisk Hemophilia and Rare Bleeding Disorders PAP. No registration or monthly fees are required.

Patient trial program

Commercially insured patients who have been prescribed a Novo Nordisk hemophilia and rare bleeding disorder product may be eligible to receive a limited supply for free.

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© 2022 Novo Nordisk  All rights reserved. US21NC00019  March 2022