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.

If you have lost your health insurance coverage because of a change in job status due to COVID-19, you may be eligible for a free 90-day supply of insulin. See COVID-19 exceptions below.

See if you qualify for the PAP

Eligibility requirements:

  • I am a US citizen or legal resident
  • My total household income is at or below 400% of the federal poverty level (FPL). Visit the NeedyMeds website, which lists the current FPL guidelines
  • I have no insurance or I have Medicare
  • I am not enrolled in and don’t qualify for any other federal, state, or government program such as Medicaid, Low Income Subsidy, or Veterans (VA) Benefits
    • Exceptions include people who are Medicaid-eligible who have applied for and been denied Medicaid
  • See eligibility requirements for Minnesota residents

COVID-19 job-loss exceptions:

Application process changes if your benefits have been affected by COVID-19.

Documentation required:

  • 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, you will receive a free 90-day supply of insulin. Novo Nordisk will check back with you (before your 90-day enrollment ends) to determine continued eligibility. Assistance can be extended for otherwise eligible patients who have been denied Medicaid coverage.

If this exception doesn’t apply to you, see all options for saving on your Novo Nordisk insulin.

Questions?

Please call Novo Nordisk toll-free at 1-866-310-7549.

How to apply

Download and fill out the application

  • Complete the following sections:
    • Part 2: Patient Information
    • Part 3: Patient Certification and Authorization

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 Individual 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/LIS denial
  • Applications to participate in PAP by 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

Patient Assistance Program Forms

PAP Application Form (English)

 

Download now

PAP Application Form (Español)

 

Download now
All Claims (v6new) NovoCare

Tresiba® Selected Important Safety Information

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.

Who should not take Tresiba®?

Do not take Tresiba® if you:

  • are having an episode of low blood sugar
  • are allergic to Tresiba® or any of the ingredients in Tresiba® 

Before taking Tresiba®, tell your health care provider about all your medical conditions, including if you are:

  • pregnant, planning to become pregnant, or are breastfeeding
  • taking new prescription or over-the-counter medicines, vitamins, or herbal supplements

Talk to your health care provider about low blood sugar and how to manage it.

How should I take Tresiba®?

  • Read the Instructions for Use and take Tresiba® exactly as your health care provider tells you to
  • Do not do any conversion of your dose. The dose counter always shows the selected dose in units
  • Know the type and strength of insulin you take. Do not change the type of insulin you take unless your health care provider tells you to
  • Change (rotate) your injection sites within the area you choose with each injection to reduce your risk of getting lipodystrophy (pits in skin or thickened skin) and localized cutaneous amyloidosis (skin with lumps) at the injection sites.
    • Do not use the exact same spot for each injection.
    • Do not inject where the skin has pits, is thickened, or has lumps.
    • Do not inject where the skin is tender, bruised, scaly or hard, or into scars or damaged skin.

What is Tresiba® (insulin degludec injection) 100 U/mL, 200 U/mL?

  • Prescription Tresiba® is a long-acting insulin used to control high blood sugar in adults and children who are 1 year of age and older with diabetes
  • Tresiba® is not for people with diabetic ketoacidosis
  • It is not known if Tresiba® is safe and effective in children under 1 year of age
  • Tresiba® is available in 2 concentrations: 200 units/mL and 100 units/mL

Tresiba® Important Safety Information

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.

Who should not take Tresiba®?

Do not take Tresiba® if you:

  • are having an episode of low blood sugar
  • are allergic to Tresiba® or any of the ingredients in Tresiba®

Before taking Tresiba®, tell your health care provider about all your medical conditions, including if you are:

  • pregnant, planning to become pregnant, or are breastfeeding
  • taking new prescription or over-the-counter medicines, vitamins, or herbal supplements

Talk to your health care provider about low blood sugar and how to manage it.

How should I take Tresiba®?

  • Read the Instructions for Use and take Tresiba® exactly as your health care provider tells you to
  • Do not do any conversion of your dose. The dose counter always shows the selected dose in units
  • Know the type and strength of insulin you take. Do not change the type of insulin you take unless your health care provider tells you to
  • Change (rotate) your injection sites within the area you choose with each injection to reduce your risk of getting lipodystrophy (pits in skin or thickened skin) and localized cutaneous amyloidosis (skin with lumps) at the injection sites.
    • Do not use the exact same spot for each injection.
    • Do not inject where the skin has pits, is thickened, or has lumps.
    • Do not inject where the skin is tender, bruised, scaly or hard, or into scars or damaged skin.
  • Adults - If you miss or are delayed in taking your dose of Tresiba®:
    • Take your dose as soon as you remember, then continue with your regular dosing schedule
    • Make sure there are at least 8 hours between doses
  • If children miss a dose of Tresiba®:
    • Call the healthcare provider for information and instructions about checking blood sugar levels more often until the next scheduled dose of Tresiba®
  • For children who need less than 5 units of Tresiba® each day, use a Tresiba® U-100 vial
  • Check your blood sugar levels. Ask your health care provider what your blood sugar levels should be and when you should check them
  • Do not reuse or share your needles or syringes with other people. You may give them a serious infection, or get a serious infection from them
  • Never inject Tresiba® into a vein or muscle
  • Never use a syringe to remove Tresiba® from the FlexTouch® pen

What should I avoid while taking Tresiba®?

  • Do not drive or operate heavy machinery, until you know how Tresiba® affects you
  • Do not drink alcohol or use prescription or over-the-counter medicines that contain alcohol

What are the possible side effects of Tresiba®?

Tresiba® may cause serious side effects that can be life-threatening, including:

  • Low blood sugar (hypoglycemia). Signs and symptoms that may indicate low blood sugar include anxiety, irritability, mood changes, dizziness, sweating, confusion, and headache
  • Low potassium in your blood (hypokalemia)
  • Heart failure in some people if taken with thiazolidinediones (TZDs). This can happen even if you have never had heart failure or heart problems. If you already have heart failure, it may get worse while you take TZDs with Tresiba®. Tell your health care provider if you have any new or worse symptoms of heart failure including shortness of breath, tiredness, swelling of your ankles or feet, and sudden weight gain

Your insulin dose may need to change because of change in level of physical activity or exercise, increased stress, change in diet, weight gain or loss, or illness.

Common side effects may include reactions at the injection site, itching, rash, serious allergic reactions (whole body reactions), skin thickening or pits at the injection site (lipodystrophy), weight gain, and swelling of your hands and feet.

Get emergency medical help if you have trouble breathing, shortness of breath, fast heartbeat, swelling of your face, tongue, or throat, sweating, extreme drowsiness, dizziness, or confusion.

Please click here for Tresiba® Prescribing Information.

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. US20NC00063  October 2020