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Patient Assistance Information

 
1 Program for NovoLog FlexPen
 
 
Novo Nordisk Diabetes Patient Assistance Program

PO Box 181640
Louisville, KY 40261
Phone : (866)310-7549
Fax: (866)441-4190
Eligibility
> Patient cannot have or qualify for any government prescription coverage such as Medicare, Medicaid, Veteran's Administration or any state or local programs. Patient cannot have or qualify for any private prescription coverage. Patient's total household income must be at or below 200% of the Federal Poverty Level.
Who Can Apply
> The doctor and patient must complete the application process.
Required
> The application must be completed and signed by the healthcare practitioner and the patient. Proof of income must also accompany the application.
Supply
> Approved patients will receive a 90 day supply of medication.
Ship To
> If approved the medication will be shipped to the healthcare practitioner's office or pharmacy.
Note
> Novo Nordisk reserves the right to modify or cancel this program at any time without notice. All requests are subject to product availablility and patient eligibility verification.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Novolog FlexPen
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Novo Nordisk Diabetes Patient Assistance Program
(Requires Acrobat Reader