Patient Assistance Program
The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to people living with diabetes. The Novo Nordisk PAP provides medication at no cost to those who qualify. There is no registration charge or monthly fee for participating.
Click here for a list of 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 Novo Nordisk PAP provides medication at no cost to those who qualify. 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 eligibility requirements
To be eligible for this program, your patient must:
- Be a US citizen or legal resident
- Have a household income at or below 400% of the federal poverty level (FPL). Visit the NeedyMeds website, which lists the current FPL guidelines
- Have Medicare or no insurance (Note: Patients with private or commercial insurance are not eligible for the PAP)
- Not be enrolled in or qualify for any other federal, state, or government program such as Medicaid, Low Income Subsidy, or Veterans Affairs (VA) Benefits
- 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)
Start an application online on behalf of your patient
(instead of using the paper application)
PAP Application Forms
PAP Refill and Change Request Forms
Questions? Call Novo Nordisk toll-free at 1‑866‑310‑7549.
If your patient is applying by paper
PATIENT
Steps for your patient to follow
- Download the application in English or en Español
- Fill out, sign, and date the patient sections
Novo Nordisk will verify your patient’s income digitally using the patient information they provide
However, if your patient believes the income is incorrect or has questions, they can supply proof of income by making a copy of one of the following items to show their adjusted gross annual household income:
- 2 most current paycheck stubs or earning statements for all working members in the household
- Last year’s federal Individual Income Tax Return (1040)
- Social Security income, pension, and other income statements
- W-2 or 1099 form
- Unemployment benefit statement
HEALTH CARE PROFESSIONAL
Steps for you to follow
- Fill out the “Prescriber Section” 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. (Important: Faxes must be sent from your office)
Note: Do not include patient medical records with this application.
- After the application is reviewed, you and your patient will be informed of the decision. If approved, an initial 120-day supply of medicine will be sent to your office, where your patient can pick it up. Please allow up to 10 business days for processing and outcome
Click here for a full list of available products.
Reminder:
In lieu of a paper application, you can start an online application for your patient now.
Important reminders for Medicaid and Medicare enrollees
Reminders
- 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 PAP by Medicare enrollees must be submitted by November 30th of each calendar year
Additional options for residents of Colorado, Maine, and Minnesota through the State Insulin Safety Net Program
In the event that your patient would like to apply for insulin assistance through the insulin safety net program in their state, the requirements and downloadable application are available below.
Colorado
Maine
Who is eligible for this program?
- Be a resident of Maine who is able to provide one of the following:
- Valid Maine driver’s license or permit
- Valid Maine identification card; or
- If the person who needs insulin is under the age of 18, the parent or legal guardian must provide proof of residency
- Not be enrolled in Medical Assistance or MaineCare
- Have a total household income at or below 400% of the current federal poverty level (FPL)
- Not be eligible to receive health care benefits through federally funded programs, with the exception of Medicare Part D
- Not be enrolled in or eligible to receive prescription drug benefits through the Department of Veterans Affairs
- Have an out-of-pocket cost of more than $75 for a 30-day supply of insulin if they have private prescription drug coverage, regardless of the type or amount of insulin needed
Continuing Need Safety Net Program
Continuing Need Safety Net Program Refill/Change Request Form
Minnesota
Who is eligible for this program?
- Be a resident of Minnesota who is able to provide one of the following:
- Valid Minnesota driver’s license or permit
- Valid Minnesota identification card
- Valid tribal identification card from a Minnesota tribe; or
- If the person who needs insulin is under the age of 18, the parent or legal guardian must provide proof of residency
- Not be enrolled in Medical Assistance or MinnesotaCare
- Have a total household income at or below 400% of the federal poverty level (FPL)
- Not be eligible to receive health care benefits through federally funded programs, with the exception of Medicare Part D
- Not be enrolled in or eligible to receive prescription drug benefits through the Department of Veterans Affairs
- Have an out-of-pocket cost of more than $75 for a 30-day supply of insulin if they have private prescription drug coverage
Continuing Need Safety Net Program
Continuing Need Safety Net Program Refill/Change Request Form
How to renew your patient's prescription
How to renew your patient's prescription
All new applicants will be automatically enrolled in auto refills. If you have a patient currently enrolled in PAP, you will receive a reorder reminder from Novo Nordisk before your patient is due for a refill. You will need to place a reorder during the calendar year for which your patient has been approved to receive medicine. Reorders can be requested by completing and submitting the Refill Request Form below or by calling Novo Nordisk toll-free at 1-866-310-7549.
Patients can renew each year for as long as they qualify. For uninsured patients, an approved application is valid for 12 months. For patients with Medicare Part D coverage, an approved application is valid for the benefit year only. Some restrictions may apply.
Novo Nordisk reserves the right to modify or cancel this program at any time without notice.
Frequently asked questions
The below frequently asked questions are intended for the general PAP application. If your patient lives in Maine, Minnesota, or Colorado, please refer to the state-specific programs for more details.
Eligibility
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. Note: Patients with private or commercial insurance are not eligible for the PAP.
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
Applying online is a step-by-step process that tells your patient what to do next, with questions and answers. However, if your patient doesn't have internet access or is simply more comfortable applying by paper, this is also a great option.
Please note: Patients who speak Spanish will need to use the paper/PDF format.
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 message.
Health care providers will receive a letter via fax.
Uninsured patients are enrolled for 12 months. Medicare patients are enrolled for a calendar year.
Your patient's medication should arrive at your office within 10-14 business days of approval.
Medication shipment and availability
Unfortunately, we are currently not able to ship directly to patients.
Unfortunately, we are currently not able to ship directly to a pharmacy.
Unfortunately, we do not currently offer the ability to schedule delivery of your patient’s medication for certain days of the week or for a specific time of the day. Our medications ship to the prescriber and, in most cases, are delivered Monday through Friday.
Please keep your latest contact information up to date with us and, as a courtesy, we will attempt to notify you prior to each shipment via fax. You can also use our automated phone system to obtain tracking information by calling 1-866-310-7549.
Although we do our best to provide timely access to most program medications, their availability and delivery are not guaranteed. For example, the medications we offer are not always available on hand for delivery 365 days of the year. We typically notify the prescriber when availability or delivery of medications may be impacted.
In certain instances, we reserve the right to adjust the quantity of medication prescribed to align with our program guidelines. For example, Medicare Part D patient enrollments expire at the conclusion of each calendar year. Therefore, approved applicants that are also enrolled with Medicare Part D may receive less than the full quantity of their prescribed medication. However, if you believe there was an error in the quantity shipped, please contact us at 1-866-310-7549.
Change of doctor or address
Please contact us at 1-866-310-7549 so we can update your records.
Please contact us at 1-866-310-7549 so we can provide additional direction.
Auto refill
Auto refill is currently available for new applicants only.
If an application is submitted with all of the supporting documentation and all required fields completed, it will be processed within 2 business days. Any missing or incomplete information may cause a delay.
With your consent, subject to program guidelines, you will receive automatic refills of your patient's medication for the duration of their enrollment.
Minnesota and Maine residents are currently not eligible; however, we are working toward expanding this capability to Minnesota and Maine residents in the future.
Most qualify; however, some products are excluded based on certain restrictions or program guidelines. For additional information, please review the terms and conditions or call 1-866-310-7549.
All eligible prescribed medications will be refilled automatically once a patient has been fully qualified and deemed eligible for the program. Certain products are excluded. For a list of excluded products, please review the latest application or call 1-866-310-7549.
Refills will be shipped in accordance with current program guidelines. We generally do our best to automatically ship additional medication approximately 30 days prior to your patient’s medication being depleted.
You will need to submit additional documentation allowing us to manage your request. Please call 1-866-310-7549 at your earliest convenience for additional information.
Please call 1-866-310-7549 at your earliest convenience.
You may opt out at any time by calling 1-866-310-7549 or faxing your request in writing to 1-866-441-4190.
This will depend on the prescribed medication. Most ship in 120-day supply increments to adequately cover the duration of an approved enrollment.
You may opt out by calling 1-866-310-7549 or faxing your request in writing to 1-866-441-4190.
Program information
Medicare Part D
Individuals with Medicare Part D coverage may apply for next year’s PAP enrollment after October 15, {currentYear}. Please ensure patients complete the latest version of the application available online or for download above. They should be sure to enter the correct enrollment year when completing the Medicare Part D Enrollment Consent.
Auto refill
The Novo Nordisk PAP now offers automatic refills for most medications. All new applicants will be automatically enrolled. The medication will be shipped to the prescriber of an approved enrollee/applicant in accordance with current program guidelines. Auto refills terminate at the end of the patient's program enrollment period. Auto refills are managed by the prescriber. Prescribers may opt out by calling 1-866-310-7549, by faxing their request in writing to 1-866-441-4190, or by opting out on the latest application.
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