Patient Assistance Program

The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to our patients. The Patient Assistance Program provides medication at no cost to those who qualify.

Patients who are approved for the PAP may qualify to receive free medicine from Novo Nordisk. There is no registration charge or monthly fee for participating.

Click here for a list of our 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 Patient Assistance Program provides medication at no cost to those who qualify.

Patients who are approved for the PAP may qualify to receive free medicine from Novo Nordisk. 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 you qualify for the PAP

See if you qualify for the PAP

To be eligible for this program, you 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
    • If you are eligible for Medicaid, you must sign the Patient Declaration section of the latest version of the PAP application stating that you 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)

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

STEP 1

Download and fill out the application

  • Applications are available in English and en Español
  • Complete the following sections: 
    • Patient Information Section
    • Insurance
    • Income
    • Patient Consent, Declaration, and Authorization

STEP 2

Gather proof of income

  • Make a copy of one of the following items to show your adjusted gross annual household income: 
    • 2 most current paycheck stubs or earning statements for all working members of your household
    • Last year’s Federal Income Tax Return (1040)
    • Social Security income, pension, and other income statements
    • W-2 or 1099 forms
    • Unemployment benefit statements

STEP 3

Ask your health care provider to complete the application

  • Take your application and proof of income to your health care provider and have them: 
    • Complete the Prescriber and Rx sections 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. Faxes must be sent from your health care provider’s office

Please allow up to 10 business days for processing.

Note: After the application is reviewed, you and your health care provider will be informed of the decision. If approved, your medicine will be sent to your health care provider’s office, where you can pick it up.

Product availability subject to change without notice.

Novo Nordisk reserves the right to modify or cancel this program at any time without notice.

  • Take your application and proof of income to your health care provider and have them: 
    • Complete the Prescriber and Rx sections 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. Faxes must be sent from your health care provider’s office

Please allow up to 10 business days for processing.

Note: After the application is reviewed, you and your health care provider will be informed of the decision. If approved, your medicine will be sent to your health care provider’s office, where you can pick it up.

Product availability subject to change without notice.

Novo Nordisk reserves the right to modify or cancel this program at any time without notice.

Important

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 the PAP by individuals with Medicare must be submitted by November 30th of each calendar year, and qualified Medicare patients will be enrolled in the program through December 31st of the calendar year

Important

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 the PAP by individuals with Medicare must be submitted by November 30th of each calendar year, and qualified Medicare patients will be enrolled in the program through December 31st of the calendar year

PAP Application Form (English)

PAP Application Form (Español)

Eligibility and enrollment

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. 

Uninsured patients are enrolled for 12 months. Medicare patients are enrolled for a calendar year. 

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 recorded phone message notification.

Health care providers will receive a letter via fax.

Once approved, a patient's medication should arrive at their prescriber's office within 10-14 business days.

Medication shipment

Unfortunately, we are currently not able to ship directly to patients. 

Unfortunately, we are currently not able to ship directly to a pharmacy. 

Change of doctor or address

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.

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 update your records.

Please contact us at 866-310-7549 so we can update your records.

PAP reapplication

Yes. Patients will need to submit a new application and supporting documentation when their enrollment ends if they'd like to be considered for continued support. Patients should be sure to submit the latest version of the application, which is available on this page in the "Patient Assistance Program forms" section above.

Patients may submit a new application 30 days prior to the end of their enrollment. Medicare Part D patients may apply after October 15th of the current year to enroll for the following year.

Program updates

Program updates

Medicare Part D

Individuals with Medicare Part D coverage may apply for 2023 PAP enrollment after October 15th, 2022. Please 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.

Medicare Part D

Individuals with Medicare Part D coverage may apply for 2023 PAP enrollment after October 15th, 2022. Please 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.


Find helpful resources

Find helpful resources

Safe disposal program

It’s important to properly dispose of your used Novo Nordisk products.

Resources and education

Find tools and resources tailored to your needs at Cornerstones4Care.com.

Partnership for Prescription Assistance

If you need assistance with prescription costs, help may be available. Visit www.pparx.org or call 1‑888‑4PPA‑NOW.

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