Insulin eligibility requirements: Novo Nordisk Patient Assistance Program

The Novo Nordisk Patient Assistance Program (PAP) is based on the company’s commitment to people living with diabetes. The PAP 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.

• List of Novo Nordisk products covered by 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

COVID-19 job-loss exceptions:

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

Documentation required:

• Completed PAP application
• Documentation showing loss of healthcare benefits (job termination notice, job status change, proof that COBRA benefits being offered)
• No proof of income required

Those approved will receive a free 90-day supply of insulin. Novo Nordisk will check back with them (before their 90-day enrollment ends) to determine continued eligibility. Assistance can be extended to the end of 2020 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.

How to apply

Download and fill out the application

• Applications are available in English and en Español
• 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 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

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