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.
Si habla español, visite nuestra página del programa PAP en español.
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.
Si habla español, visite nuestra página del programa PAP en español.
To be eligible for this program, you must:
Applying online is a step-by-step process that tells you what to do next. However, you can also apply by paper. Just see the “How to apply" section on this page.
Si habla español, visite nuestra página del programa PAP en español.
Note: First, please verify your health care provider’s email address. They will get a copy of your form by email and must complete certain parts of it.
Note: Applying online is only available in English.
Before you start your application
You'll most likely need:
Note: Please verify your health care provider’s email address before beginning. Your health care provider will receive a copy of your application by email and must fill out certain portions to complete it.
Other items you may need:
Applications are available in English and Spanish.
También puede visitar nuestra página del programa PAP en español.
STEP 1: Download and fill out the application
Complete the following sections:
STEP 2: Proof of income
For your convenience, Novo Nordisk will verify your income electronically, whether you use the digital form or the paper form.
If you believe the income is incorrect or have questions, you can supply proof of income yourself. Just make a copy of one of the following items to show your adjusted gross annual household income:
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:
Please allow up to 10 business days for the processing and outcome.
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.
Do not include patient medical records with this application
In the event that you would like to apply for insulin assistance through the insulin safety net program in your state, the requirements and downloadable application are available below.
Colorado
Maine
Who is eligible for this program?
Minnesota
Who is eligible for this program?
The below frequently asked questions are intended for the general PAP application. If you live in Maine, Minnesota, or Colorado, please refer to the state-specific programs for more details.
Patient must:
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.
Applying online is a step-by-step process that tells you what to do next, with questions and answers. However, if you don’t have internet access or are simply more comfortable applying by paper, this option is available, as well.
Atención: Si habla español, use el formato en papel o PDF.
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.
Unfortunately, we are currently not able to ship directly to patients.
Unfortunately, we are currently not able to ship directly to a pharmacy.
Please contact us at 1-866-310-7549 so we can provide additional direction.
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 update your records.
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 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.
Those with Medicare Part D coverage may apply for next year’s PAP enrollment after October 15, {currentYear}. Be sure to enter the correct enrollment year when completing the Medicare Part D Enrollment Consent.
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.
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