Do not share your Tresiba® FlexTouch® with other people, even if the needle has been changed. Do not share needles or syringes with another person. You may give other people a serious infection, or get a serious infection from them.
Patient Assistance Program
The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to people living with diabetes. 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 diabetes 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 people living with diabetes. 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 diabetes 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
Eligibility requirements:
- You must be a US citizen or legal resident
- Your 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
- You cannot have any private prescription coverage, such as an HMO or PPO
- You cannot have or qualify for:
- Department of Veterans Affairs (VA) prescription benefits
- Any federal, state, or local program such as Medicare or Medicaid. Exceptions include:
- Medicare Part D patients who have spent $1,000 on prescription medicine in the current calendar year
- Patients who are Medicare eligible and do not have Medicare Part D coverage who have applied for and been denied Extra Help/Low Income Subsidy (LIS). To apply for LIS, please contact the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778) or go to ssa.gov/benefits/medicare/prescriptionhelp/
- Patients who are Medicaid eligible who have applied for and been denied Medicaid
Questions?
Please call Novo Nordisk toll-free at 1-866-310-7549.
How to apply
Download and fill out the application
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
Take the application and proof of income to your health care provider
- Your health care provider must:
- Complete the "For Health Care Practitioner" section of the application, including “Order information” (subsection D)
- 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 complete the Medicaid Eligibility form (proof of denial must be submitted if requested at any time)
- Patients who are eligible for Medicare Part D must provide proof of Medicaid or Extra Help/US denial
- Medicare Part D patients who meet the eligibility requirements must provide photocopy documentation showing $1,000 has been spent on prescription medicine for the relevant benefit year. Acceptable documentation includes a letter from plan provider, statement, explanation of benefits (EOB), or clearly dated pharmacy printout showing amount paid by the patient for each medicine.
- Applications to participate in PAP by Medicare must be submitted by November 30th of each calendar year
Patient Assistance Program Forms
Tresiba® is a prescription medication.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1‑800‑FDA‑1088.
If you need assistance with prescription costs, help may be available. Visit www.pparx.org or call 1‑888‑4PPA‑NOW.
© 2020 Novo Nordisk All rights reserved. US19NC00045 January 2020