MyInsulinRx SMS Program Terms & Conditions

MyInsulinRx™ SMS Program Terms & Conditions

Covered insulins:

NovoLog^® (insulin aspart) injection 100 U/mL
NovoLog^® Mix 70/30 (insulin aspart protamine and insulin aspart) injectable suspension 100 U/mL
Levemir^® (insulin detemir) injection 100 U/mL^a
Tresiba^® (insulin degludec) injection 100 U/mL, 200 U/mL
Fiasp^® (insulin aspart) injection 100 U/mL
Novolin^® N (isophane insulin human) injectable suspension 100 U/mL vial
Novolin^® R (insulin human) injection 100 U/mL vial
Novolin^® 70/30 (insulin isophane human and insulin human) injectable suspension 100 U/mL vial
Novolin^® 70/30 FlexPen^® (insulin isophane human and insulin human) injectable suspension 100 U/mL
Insulin Aspart Injection 100 U/mL^b
Insulin Aspart Protamine and Insulin Aspart Injectable Suspension 100 U/mL^b
Insulin Degludec Injection 100 U/mL, 200 U/mL^b

Terms and conditions:

In order to redeem this offer, patient must have a valid prescription for a covered insulin. A valid Prescriber ID# is required on the prescription. Patient is not eligible where prohibited by law. This offer may not be redeemed for cash. This offer is available for uninsured patients, patients with commercial insurance, and Medicare Part D Patients who were first enrolled in 2020 and re-enrolled each subsequent calendar year. If you are commercially insured, this offer will work outside of your insurance, will not count toward any deductibles, and cannot be applied to a patient’s maximum out-of-pocket costs. No new applicants to the program who are enrolled in any federal or state health care program with prescription drug coverage, such as Medicaid, Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program (each a government program), are eligible to enroll in this offer. Once enrolled in the program, the Savings Offer is valid for the calendar year. Novo Nordisk’s Eligibility and Restrictions, and Offer Details, may change from time to time without prior notice. For latest Terms and Conditions, please visit this page. Patients with questions may call 1-888-910-0632.

For any Medicare Part D patients who were enrolled in the Novo Nordisk My$99Insulin Program first in 2020 and who re-enrolled each subsequent calendar year thereafter, please note that in order to participate in 2024, you will need to re-enroll. By re-enrolling in the program, you certify that you will purchase all insulin prescriptions covered under this program before 12/31/24 by using the MyInsulinRx™ Savings Offer and will not use Medicare Part D benefits, even if your benefits change. Any re-enrollments in 2024 must be done either by following the instructions provided in a letter sent to your home in December 2023, or by calling 1-833-793-1861 to provide certain insurance and other enrollment information.

By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described herein, that you will not seek reimbursement for any benefit received through this offer, and that you acknowledge and agree that any amounts paid in connection with this offer cannot count toward Medicare Part D True Out-of-Pocket (TrOOP) costs.

This offer is valid only in the United States and its territories, unless prohibited by law, and may be redeemed at participating retail pharmacies. Availability of the offer in Massachusetts will be dependent upon state law in effect at the time patient presents the offer when paying for the covered medications. Void where taxed, restricted, or prohibited by law. This offer is not transferable and is limited to one offer per person. Not valid if reproduced.

Cash Discount Cards and other noninsurance plans are not valid as primary insurance under this offer. If the patient is eligible for drug beneﬁts under any such program, the patient cannot use this offer. This Savings Offer cannot be combined with any coupon, certificate, voucher, or similar offer.

By activating this offer, patient represents and warrants that he or she has not submitted, and will not submit, a claim for reimbursement to any payer or prescription insurance plan, including any government program, for this prescription. Patient is responsible for complying with any insurance carrier disclosure requirements, including disclosing any savings received from this program. It is illegal to (or offer to) sell, purchase, or trade this offer.

This program is not health insurance. This program is managed by ConnectiveRx on behalf of Novo Nordisk. The parties reserve the right to rescind, revoke, or amend this offer without notice at any time.

Offer details:

Eligible patients may pay $35 for a monthly supply of any combination of Novo Nordisk insulin products (up to 3 vials or 2 packs of pens). Once enrolled, the Savings Offer is valid for each month during the calendar year. Re-enrollment is required each year. This cost does not apply to any deductibles or maximum out-of-pocket costs you may have.

Pharmacist

When you apply this offer, you are certifying that you have not submitted a claim for reimbursement to any payer or prescription insurance plan, including any government program, for this prescription, or where prohibited by law. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the eligibility criteria, and terms and conditions described herein. You also certify that you will not seek reimbursement for any benefit received through this offer or apply the benefit received to the True Out-of-Pocket (TrOOP).

Pharmacist instructions:

Patient is not eligible if he/she seeks reimbursement from any payer or prescription insurance plan.

Submit each claim to SS&C Health using BIN 019158. A valid Other Coverage Code (eg, 0 or 1) is required. The patient is responsible for the first $35 per 35 mL of any combination of covered insulins, and reimbursement will be received from SS&C Health.

Patient will pay $35 per 35 mL (ie, up to 3 vials or 2 packs of pens or any combination thereof), up to a maximum of 150 mL per calendar month. Once enrolled in the program, the Savings Offer is valid for the calendar year.

For any questions regarding SS&C Health online processing, please call the Pharmacy Help Desk at 1-844-373-0987.

MYINSULINRX™ SAVINGS SMS PROGRAM TERMS OF USE
Last Updated 9/13/23 (effective date)

Agreement Generally: Acceptance. These “Terms of Use” (the “Agreement” or “Terms of Use”) are between you and Novo Nordisk’s MyInsulinRx™ Savings Offer SMS Program (“MyInsulinRx™ Savings SMS Program,” “we,” “us,” or “our”). “You” means you personally. This Agreement sets forth the terms and conditions upon which we make available the MyInsulinRx™ Savings SMS Program and its contents and offerings to you.

Please note these Terms of Use govern only the MyInsulinRx™ Savings SMS Program, and not any other service, program, or website. By participating in the MyInsulinRx™ Savings SMS Program, you are agreeing to these Terms of Use. By using the MyInsulinRx™ Savings SMS Program, you affirm that you are a US resident, 18 years of age or older, qualify for the MyInsulinRx™ Savings SMS Program, and expressly consent to receive communications from Novo Nordisk or its partners in connection with the MyInsulinRx™ Savings SMS Program. Your consent to receive marketing messages is not required for the receipt of goods or services from Novo Nordisk.

For more information about data use and collection, please read the most recent version of Novo Nordisk’s Privacy Statement. PLEASE READ THESE TERMS OF USE CAREFULLY, INCLUDING YOUR COMMUNICATION OPTIONS, BEFORE ATTEMPTING TO ENROLL IN THE MYINSULINRX™ SAVINGS SMS PROGRAM.

IF YOU DO NOT AGREE, YOU CANNOT ENROLL IN THE MYINSULINRX™ SAVINGS SMS PROGRAM.

Eligibility. To participate in the MyInsulinRx™ Savings SMS Program, you must be a resident of the United States and 18 years of age or older. Novo Nordisk reserves the right to require you to prove that you are at least 18 years of age.
Modifications to Terms of Use. You agree that we may modify these Terms of Use and that such modifications shall become effective immediately upon posting of the modified Terms of Use to our website or otherwise notifying you of an update through one or more components of the MyInsulinRx™ Savings SMS Program. If you do not accept the modifications, then you must cease using the MyInsulinRx™ Savings SMS Program. The Terms of Use contain the date of posting at the top of the first page. Any revised version of the Terms of Use will only apply to those individuals who sign up for the MyInsulinRx™ Savings SMS Program after the effective date. If you have previously signed up for the MyInsulinRx™ Savings SMS Program under a prior version of these Terms of Use, you will not be required to adhere to any additions and/or requirements unless you expressly agree.
Permission to Use MyInsulinRx™ Savings SMS Program; Limitations on Use of MyInsulinRx™ Savings SMS Program. Subject to your voluntary acceptance and while you remain in compliance with the Terms of Use, we grant you a limited, revocable, non-exclusive, non-transferable license to use the MyInsulinRx™ Savings SMS Program solely and exclusively for your own personal use and not for any other purpose. This license is solely and exclusively for your benefit. All other uses of the MyInsulinRx™ Savings SMS Program are prohibited.

Communication Options. By choosing to enroll in the MyInsulinRx™ Savings SMS Program, you consent/opt in to the option of receiving text messages from the MyInsulinRx™ Savings SMS Program. After you complete your initial enrollment in the MyInsulinRx™ Savings SMS by phone, you will receive a welcome text to complete your enrollment process and to further opt in to your preferred method of communication with the MyInsulinRx™ Savings SMS Program. We do not guarantee that MyInsulinRx™ Savings SMS Program communications will be received and are not responsible for lost or misdirected communications.

To get additional MyInsulinRx™ Savings Support, text “HELP” to 24177 or call 1-888-910-0632.

To opt out of receiving text messages from Novo Nordisk or its partners related to the MyInsulinRx™ Savings SMS Program, text “STOP” to 24177 or call 1-800-727-6500.

If you opt out of the MyInsulinRx™ Savings, any future data collection in the MyInsulinRx™ Savings from you will end. Any data previously collected through the MyInsulinRx™ Savings may be stored by Novo Nordisk. PLEASE NOTE that opting out of the MyInsulinRx™ Savings does not unsubscribe and/or opt you out of any other communications from Novo Nordisk or its partners that you may have previously signed up for separate and apart from the MyInsulinRx™ Savings. You may separately opt out of all marketing communications from Novo Nordisk by simply clicking the “Unsubscribe” link within any email you receive from Novo Nordisk or its partners, or by calling 1-800-727-6500, or clicking here, or by sending Novo Nordisk a letter containing your name, email address, and phone number, to Novo Nordisk, 800 Scudders Mill Road, Plainsboro, New Jersey 08536.

Text Messaging. If you choose to communicate in the MyInsulinRx™ Savings SMS Program by text message, the following terms apply:
1. Text Message Frequency. The MyInsulinRx™ Savings SMS Program’s message frequency varies. Please be aware that Novo Nordisk brands and services may have separate text messaging programs. The total number of text messages you receive from Novo Nordisk or its partners, therefore, may vary based on the number of Novo Nordisk text messaging programs for which you sign up to receive messages.
2. Cost. You will not be charged any fee from Novo Nordisk or its partners in connection with the MyInsulinRx™ Savings SMS Program. However, Novo Nordisk encourages you to check with your mobile service provider to see what other message and data rates may apply, including any applicable roaming charges. Novo Nordisk is not responsible for any fees or charges from any carrier or service provider related to MyInsulinRx™ Savings SMS Program communications.
3. Supported Carriers. The following US carriers are supported:
  1. Major Carriers: AT&T, Verizon Wireless, Sprint, and T-Mobile USA.
  2. Minor Carriers: Aio Wireless, Alaska Communications Systems (ACS), Appalachian Wireless (EKN), Bluegrass Cellular, Boost Mobile, Carolina West Wireless, CellCom, Cellular One of East Central IL (ECIT), Cellular One of Northeast Arizona, Cellular One of Northeast Pennsylvania, Chariton Valley Cellular, Cricket, Coral Wireless (MobiPCS), Cross, C-Spire (CellSouth), Duet IP (Maximum Communications New Core Wireless), Element Mobile (Flat Wireless), Epic Touch (Elkhart Telephone), GCI, Golden State, Google Voice, Hawkeye (Chat Mobility), Hawkeye (NW Missouri), Illinois Valley Cellular, Inland Cellular, iWireless (Iowa Wireless), Keystone Wireless (Immix Wireless/PC Man), Metro PCS, Mosaic (Consolidated or CTC Telecom), MTA Communications, MTPCS (Cellular One Nation), Nex-Tech Wireless, Panhandle Communications, Peoples Wireless, Pine Cellular, Pioneer, RINA, Sagebrush Cellular (Nemont), SI Wireless/Mobile Nation, Simmetry (TMP Corporation), SouthernLinc, SRT Wireless, Thumb Cellular, Union Wireless, United Wireless, U.S. Cellular, Viaero Wireless, Virgin Mobile, and West Central (WCC or 5 Star Wireless).
4. Your Mobile Telephone Number. You represent that you are the account holder or authorized user for the mobile telephone number you opt in to receive text messages for the MyInsulinRx™ Savings SMS Program.
5. Access or Delivery to Mobile Network Is Not Guaranteed. Delivery of information and content to a mobile device is not guaranteed and may fail to due to a variety of circumstances or conditions. Alerts sent via text message may not be delivered if the mobile phone is not in range of a transmission site, or if sufficient network capacity is not available at a particular time. Even within a coverage area, factors beyond the control of the wireless carrier may interfere with message delivery, including the customer's equipment, terrain, proximity to buildings, foliage, and weather. Novo Nordisk will not be held responsible for any delays in the receipt of any text messages as delivery is subject to effective transmission from your mobile service provider or network operator. You understand and acknowledge that network services, including but not limited to mobile network services, are outside of Novo Nordisk’s control, and Novo Nordisk is not responsible or liable for issues arising from them. Note that there may be data or message fees imposed by your carrier or service provider if you choose to receive text messages from the MyInsulinRx™ Savings SMS Program.

Privacy. In order to enroll in the MyInsulinRx™ Savings SMS Program, you may provide us with your phone number. We require this information in order to communicate with you, provide you with the MyInsulinRx™ Savings SMS Program, and to send you MyInsulinRx™ Savings SMS Program materials. Your information will be shared between Novo Nordisk and its service providers who support the MyInsulinRx™ Savings SMS Program in accordance with applicable laws. Novo Nordisk and its service providers may share information that does not individually identify you without restriction in accordance with applicable laws. Novo Nordisk understands and values the importance of your privacy. In accordance with these Terms of Use, Novo Nordisk may use your information for program improvements, quality monitoring, data and analytics for Novo Nordisk commercial purposes, and future Novo Nordisk marketing communications (including branded or unbranded emails, text messages, or direct mail). For more information on how we collect and use your information, please read our full Privacy Statement.
Security. By enrolling in the MyInsulinRx™ Savings SMS Program, you understand that Novo Nordisk is not a “Covered Entity” or “Business Associate” under the Health Information Privacy Rule (or “HIPAA”) that requires protection of a patient’s confidential information. By releasing your personal information to Novo Nordisk, you acknowledge that this information will not be protected by HIPAA but will be protected by reasonable security measures.
Content. All information available in or provided through the MyInsulinRx™ Savings SMS Program is collectively referred to in these Terms as the “Content.” The Content may include Savings Offer information along with refill reminders. You may not sell, give, reproduce, create derivative works of, publicly display, or otherwise distribute the Content to anyone other than your physician(s) or caregiver(s). All rights not expressly granted herein are reserved. Novo Nordisk assumes no responsibility for the accuracy or appropriateness of any information provided by you through the MyInsulinRx™ Savings SMS Program.

NOT MEDICAL ADVICE. This program does not substitute medical advice from your health care provider. You will have to contact him or her directly about issues, questions, or concerns. The MyInsulinRx™ Savings SMS Program may provide you with support, encouragement, practical tips, and accountability to help you achieve your health goals. The MyInsulinRx™ Savings SMS Program does not give medical advice. OUR CONTENT AND COMMUNICATIONS ARE NOT INTENDED TO BE A REPLACEMENT OR SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. THE CONTENT AND COMMUNICATIONS DO NOT CONSTITUTE MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. YOU ACKNOWLEDGE AND UNDERSTAND THAT YOU WILL SEEK THE ADVICE OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER WITH ANY QUESTIONS THAT ARISE REGARDING ANY MEDICAL CONDITION. YOU ACKNOWLEDGE THAT ALL INFORMATION AND GUIDANCE PROVIDED BY YOU IS SOLELY AT YOUR OWN RISK. You understand that Novo Nordisk does not endorse any particular physician or health care provider for the treatment of any specific medical condition. You further understand that this program is not a means to communicate product issues or negative side effects to Novo Nordisk. You are encouraged to report negative side effects of prescription drugs to the FDA at www.fda.gov/medwatch, or by phone at 1-800-FDA-1088. Novo Nordisk is not responsible for monitoring or recording text messages that may constitute an issue or negative side effect. However, if you are using a Novo Nordisk Product as treatment, and some of your entered responses can be interpreted as a side effect of the medication, Novo Nordisk reserves the right to contact you for more information by phone or written communication. For additional information about your medication, please call Novo Nordisk Customer Care at 1-833-693-6742.

Prohibited Activity. You will not: (a) access or attempt to access the MyInsulinRx™ Savings SMS Program or any part thereof that you are not authorized to access or through any means that you are not authorized to use; (b) disrupt or interfere with the security of, or otherwise cause harm to, the MyInsulinRx™ Savings SMS Program, systems, resources, accounts, passwords, servers, or networks connected to or accessible through the MyInsulinRx™ Savings SMS Program or any affiliated or linked websites, or access or use the MyInsulinRx™ Savings SMS Program in any manner that could damage, disable, overburden, or impair any server or network used by us in connection with the MyInsulinRx™ Savings SMS Program; (c) use the MyInsulinRx™ Savings SMS Program to transmit any information of a sensitive nature, such as health information, Social Security numbers, credit card numbers (other than as strictly allowed), or any other information that, if generally exposed, could lead to identity theft, financial fraud, embarrassment, or other harm; (d) use the MyInsulinRx™ Savings SMS Program in any manner that infringes upon or violates any intellectual property rights or other rights or interest of any party or otherwise constitutes pornography, defamation, harassment, bullying, predatory behavior, false and deceptive advertising, or hate speech; (e) submit any software, programs, or files via the MyInsulinRx™ Savings SMS Program that are harmful or disruptive of another’s equipment, software, or other property, including any corrupted files, time bombs, Trojan Horses, viruses, and worms; (f) disrupt, interfere with, or inhibit any other user from using and enjoying the MyInsulinRx™ Savings SMS Program; (g) violate any applicable laws or regulations related to the access to or use of the MyInsulinRx™ Savings SMS Program, and/or engage in any activity prohibited by the Terms of Use; (h) compile, use, download, or otherwise copy any materials available on the MyInsulinRx™ Savings SMS Program (except as expressly permitted), or transmit, provide, or otherwise distribute (whether or not for a fee) such materials to any third party; (i) use, or allow anyone else to use, any robot, spider, or other such programmatic or automatic device, including but not limited to automated dial-in or inquiry devices, to obtain information from the Site or otherwise monitor or copy any portion of the MyInsulinRx™ Savings SMS Program; (j) frame, mirror, or use framing techniques on any part of the MyInsulinRx™ Savings SMS Program without our express prior written consent; (k) make any use of, or allow anyone else to make any use of, data extraction, scraping, mining, or other data gathering tools, or create a database by systematically downloading or storing the MyInsulinRx™ Savings SMS Program, or any portion thereof, or otherwise scrape, collect, store, or use the MyInsulinRx™ Savings SMS Program, except pursuant to the limited license granted by the Terms of Use; (l) modify, adapt, translate, reverse engineer, decompile, or disassemble any portion of the MyInsulinRx™ Savings SMS Program; or (m) remove any copyright, trademark, or other proprietary rights notice from the MyInsulinRx™ Savings SMS Program. These examples of prohibited conduct are illustrative and are not exhaustive.

TO THE MAXIMUM EXTENT AUTHORIZED BY LAW, WE RESERVE THE RIGHT, BUT DISCLAIM ANY OBLIGATION WHATSOEVER, TO MONITOR OUR SITE AND YOUR COMPLIANCE WITH THIS SECTION AND WITH THE TERMS OF USE AS A WHOLE.

Termination of MyInsulinRx™ Savings SMS Program. Novo Nordisk may suspend or terminate your use of the MyInsulinRx™ Savings SMS Program if Novo Nordisk believes you are in breach of these Terms of Use. Your receipt of MyInsulinRx™ Savings SMS Program communications is also subject to termination in the event that your telephone or network service terminates or lapses. Novo Nordisk reserves the right to modify or discontinue, temporarily or permanently, all or any part of the MyInsulinRx™ Savings SMS Program with or without notice. You assume sole responsibility for the proper use and scheduling of any medications, treatments, and procedures related to your health care and disease management.
Assignment. You may not assign any of your rights or obligations hereunder, whether by operation of law or otherwise, without our prior written consent. Notwithstanding the foregoing, we may freely assign the Terms of Use, and the rights and obligations therein, without your consent, including but not limited to, in connection with a merger, acquisition, corporate reorganization, or sale of all or substantially all of our assets. Subject to the foregoing, the Terms of Use shall bind and inure to the benefit of the parties, their respective successors and permitted assigns.
Entire Agreement. This Agreement, including the documents incorporated herein by reference, is the entire understanding and agreement between MyInsulinRx™ Savings SMS Program and you with respect to the subject matter hereof.
Miscellaneous. The invalidity or unenforceability of any provision of this Agreement shall not affect the validity or enforceability of any other provision. To the event that any provision of this Agreement is found to be invalid or unenforceable, this Agreement shall be construed in accordance with its terms as if the invalid or unenforceable provision was not contained therein. No delay or failure by MyInsulinRx™ Savings SMS Program to enforce any provision of this Agreement shall be a waiver of any of our rights under this Agreement.

^aDiscontinuation Notice: Please be aware that Novo Nordisk will be discontinuing Levemir^® in the US. This savings offer will continue to work for Levemir^® FlexPen^® and Levemir^® vials while supplies last at your pharmacy. Before supplies are disrupted or discontinued, please talk to your health care provider about other options to continue your treatment. If you have any questions, please contact your health care provider or call the Novo Nordisk Customer Care Center at 1-800-727-6500.

^bUnbranded biologic from Novo Nordisk Pharma, Inc. (NNPI)