Patient Assistance Program

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.

Patient Assistance Program

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.

Who can participate in the Patient Assistant Program?

• Be a US citizen or legal resident
• Have a total household income that is 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
• 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
  • If you are eligible for Medicaid, you must sign the Patient Declaration section of the latest version of the PAP application stating that you 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)

  

  Apply for the PAP online

  Applying online can be fast and easy. It’s a step-by-step process that tells you what to do next. However, you can also apply by paper. Just see “PAP Application Forms” on this page.

  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.

  

  PAP Application Forms

  

  Questions

  See the frequently asked questions below or call Novo Nordisk toll-free at 1‑866‑310‑7549.

  How to apply

  

  Start applying online

  Note: Applying online is only available in English. Before you start your application You'll most likely need:
  1. Your health care provider's:
     • Name
     • State
     • Email address

  

  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.

  1. If you have Medicare, your insurance card(s)

  Other items you may need:

  1. Your tax documents from the most recent year you filed taxes
  2. Proof of income

  

  Apply by paper application

  Applications are available in English and en Español

  STEP 1: Download and fill out the application

  Complete the following sections:

  • Patient Information Section
  • Insurance
  • Income
  • Medicare Part D consent (if applicable)
  • Patient Declaration, Authorization, Consent to be Contacted, and Fair Credit Reporting Act (FCRA) Consent

  STEP 2: 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

  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:

  • Complete the Prescriber and Rx sections 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. Faxes must be sent from your health care provider's office

  Please allow up to 10 business days for the 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 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 the PAP by individuals with 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

  Additional options for residents of Colorado, Maine, and Minnesota through the State Insulin Safety Net Program

  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.

  

  To download an application, visit the Colorado Board of Pharmacy website.

  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

    

    Apply for the Maine Continuing Need Safety Net Program.

    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

      

      Apply for the Minnesota Continuing Need Safety Net Program.

      Frequently asked questions

      Eligibility and enrollment

      Who is eligible for this program?

      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.

      If approved, how long am I enrolled in the program?

      Uninsured patients are enrolled for 12 months. Medicare patients are enrolled for a calendar year.

      I have Medicare Part D coverage. Do I need to spend $1000 in out-of-pocket prescription costs before I am able to apply to the program?

      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

      Should I apply for the PAP online or by paper?

      Applying online can be fast and easy. You'll go through a step-by-step process that tells you what to do next, with simple questions and answers. However, if you don't have internet access or are simply more comfortable applying by paper, this is also a great option.

      Please note: If you speak Spanish, please use the paper/PDF format.

      How long does it take to process an application?

      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.

      How will I know if I have been approved?

      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.

      If I have been approved, how long does it take to receive my medication?

      Once approved, a patient's medication should arrive at their prescriber's office within 10-14 business days.

      Medication shipment

      Can you ship my medication directly to my home?

      Unfortunately, we are currently not able to ship directly to patients.

      Can you ship my medication directly to a local pharmacy?

      Unfortunately, we are currently not able to ship directly to a pharmacy.

      Change of doctor or address

      What should I do if I have switched doctors?

      Please contact us at 1-866-310-7549 so we can provide additional direction.

      What should I do if I have moved?

      Please contact us at 1-866-310-7549 so we can update your records.

      What should I do if my doctor has moved?

      Please contact us at 1-866-310-7549 so we can update your records.

      PAP reapplication

      Do I have to reapply to the program when my enrollment ends?

      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 should be sure to submit the latest version of the application, which is available on this page in the "PAP Application Form" section above.

      If my enrollment is ending, how soon can I reapply to the program?

      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.

      Program updates

      

      Medicare Part D

      Individuals with Medicare Part D coverage may apply for 2023 PAP enrollment after October 15th, 2022. Please complete the latest version of the application available online or for download above. Be sure to enter the correct enrollment year when completing the Medicare Part D Enrollment Consent.

      

      Auto refill

      For added convenience and at the direction of the prescriber, the Novo Nordisk PAP now offers automatic refills for most medications.

      All new applicants will be automatically enrolled. The medication will ship to the prescriber of an approved enrollee/applicant in accordance with current program guidelines with minimal involvement on behalf of the prescriber. Auto refills terminate at the end of the patient’s program enrollment period. Auto refills are managed by the prescriber.

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