NovoCare | Savings Card for NovoLog® Mix 70/30 (insulin aspart protamine and insulin aspart injectable suspension) 100 U/mL

Are you enrolled in any government, state, or federally funded medical or prescription benefit programs? (Examples include but are not limited to Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program.)

Yes, I am enrolled

No, I am not enrolled

We’re sorry, but you are not eligible to participate in this program because you currently participate in a government, state, or federally funded prescription benefit program.

Get help managing your diabetes with Cornerstones4Care^®

Discover tools and resources tailored to your needs. You’ll get carb-friendly recipes, tips for staying active, tracking tools, educational videos, and a personalized action plan.

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Do you have commercial (also known as private) insurance that covers your prescription? (Example: Insurance provided through an employer)

Yes

We’re sorry, but you must be enrolled in a commercial insurance plan to participate in this program.

Get help managing your diabetes with Cornerstones4Care^®

Discover tools and resources tailored to your needs. You’ll get carb-friendly recipes, tips for staying active, tracking tools, educational videos, and a personalized action plan.

Start today

Tell us about yourself

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First Name*
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Last Name*
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Email Address*
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This email address is associated with an existing account. For assistance with obtaining or activating a Tresiba® Instant Savings Card, please call 1-855-834-3466, and press 5 to speak with a live operator.

This email address will become your user name.

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Welcome back! Your email address is already registered with Cornerstones4Care^®. Please log in to complete your savings card request.

Why do we need your information?

The more we know about you and your diabetes, the better we can personalize your Cornerstones4Care^® experience.

Maintaining your privacy is important to us. Please read our Privacy Policy to learn more about how we protect your personal information.

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Password*
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Must be 8 characters or more and contain at least 1 capital letter, 1 lowercase letter, and 1 number.

Retype Password*
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Security Question*
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Security Answer*

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What best describes you?*
Please indicate whether you are a patient or a caregiver.

Please indicate whether you are a patient or a caregiver.

What type of diabetes do you have?* What type of diabetes do you have?* What type of diabetes?*
Please indicate what type of diabetes you have or are helping someone manage.

Please indicate what type of diabetes you have or are helping someone manage.

Date of Birth* Date of Birth*

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You must be 18 years or over to complete enrollment. Please have a parent or legal guardian complete this form on your behalf.

You must be 18 years or over to complete enrollment. Please have a parent or legal guardian complete this form on your behalf.

Please enter a valid date of birth.

Because you are younger than 18 years old, please have a parent or guardian complete the fields below.

Parent First Name*
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Parent Last Name*
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Parent/Guardian E-mail*
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By clicking this box, I certify that I am a parent or guardian and grant permission for my child to access this website and receive communications from Novo Nordisk. I also understand that I will receive a copy of all communications sent to my child.

A parent or guardian must check this box to complete your registration. A parent or guardian must check this box to complete your registration.

What medications do you take? How long have you taken them? *

Please select at least 1 item from the medications list and a duration.

*

Please select at least 1 item from the medications list and a duration.
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What medications do you take? How long have you taken them? *

Please select at least 1 item from the medications list and a duration.

*

Please select at least 1 item from the medications list and a duration.
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I am the parent or legal guardian.*

By checking this box, I certify that I am the parent or legal guardian of a child under 18 years old with diabetes.

Please tell us about your child with diabetes.

Child's Date of Birth* Child's Date of Birth*

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Please enter your child's date of birth.

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Child's First Name*
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Child's Last Name*
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What medications does this person take? For how long? *

Please select at least 1 item from the medications list and a duration.

*

Please select at least 1 item from the medications list and a duration.
Delete medication

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What medications does this person take? For how long? *

Please select at least 1 item from the medications list and a duration.

*

Please select at least 1 item from the medications list and a duration.
Delete medication

Add another medication

Provide your contact information

Street Address 1*
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Street Address 2*

City*
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State*
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ZIP Code*
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Phone Number*

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Mobile Number*

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Please provide your phone number(s) and check the box below if you are interested in receiving calls, texts, and other Novo Nordisk service notifications from Novo Nordisk.

Yes, I would like Novo Nordisk to contact me via telephone and text message at the telephone number(s) I provided above regarding Novo Nordisk’s products, goods, or services. I understand these calls or texts may be generated using an automated technology and I do not have to consent to receive communications via telephone or text messaging before purchasing goods or receiving other services from Novo Nordisk.

If eligible, I understand that certain information pertaining to my use of the Card will be shared by my pharmacy with Novo Nordisk, the sponsor of the Card. The information disclosed will include the date I filled the prescription, amount of medication dispensed by my pharmacist, and amount I will be reimbursed by Novo Nordisk. This information may be used by Novo Nordisk to provide me with information about my prescription. Should I begin receiving prescription benefits from a federal, state, or other government-funded program at any time, I will no longer be eligible to participate in this program. You may contact me by phone or mail periodically in order to verify that my eligibility for the program has not changed.

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To complete your registration, we ask you to take a moment to read the below information to better understand how Novo Nordisk uses the information you provided us. When you finish reading, please check the “I Agree” box and confirm your age. Then click SUBMIT to complete your registration.

Novo Nordisk respects the importance of your privacy and understands your health is a very personal and sensitive subject. Novo Nordisk wants you to understand how it will use the information provided by you on this registration page. By clicking “I Agree” below, you are indicating you want to learn more about this service and receive promotional or non-promotional updates via email or mail from Novo Nordisk or its partners about products, support services, or other special opportunities that Novo Nordisk or its partners believe might be interesting to you. You also understand that you may opt out from receiving any future communications from Novo Nordisk or its partners by clicking the “unsubscribe” link within any email you receive, by calling 1.877.744.2579, or by sending us a letter containing your full contact information (e.g. name, email address, phone) to Novo Nordisk, 800 Scudders Mill Road, Plainsboro, New Jersey 08536.

To better understand how Novo Nordisk values your privacy and what other information may be collected from you while you use this service, please see our Privacy Statement.

I agree and confirm I am 18 years of age or older.*
You must check the "I Agree" box and click "Submit" to complete your Savings Card request or activation. You must check the "I Agree" box and click "Submit" to complete your Savings Card request or activation.

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Indications and Usage

Important Safety Information

What would you like to do?

Get help managing your diabetes with Cornerstones4Care^®

Get help managing your diabetes with Cornerstones4Care^®

Tell us about yourself

Why do we need your information?

Create an account

Provide your contact information

Selected Important Safety Information

Indications and Usage

Important Safety Information

Indications and Usage

Important Safety Information

What would you like to do?

Get help managing your diabetes with Cornerstones4Care®

Get help managing your diabetes with Cornerstones4Care®

Tell us about yourself

Why do we need your information?

Create an account

Provide your contact information

Selected Important Safety Information

Indications and Usage

Important Safety Information

Get help managing your diabetes with Cornerstones4Care^®

Get help managing your diabetes with Cornerstones4Care^®