NOVO NORDISK PATIENT ASSISTANCE PROGRAM

The Novo Nordisk Patient Assistance Program (PAP) encompasses our goal of continued commitment to people living with diabetes and the Novo Nordisk Triple Bottom Line. The Diabetes PAP provides free medicine to those who qualify. If approved, a free 120-day supply of medicine will be sent to the prescribing healthcare providers' office to be picked up at the patient's convenience. Novo Nordisk will automatically contact the healthcare provider 90 days later to approve the medication refill.

If you are a patient in need of assistance or know someone in need of assistance, follow these 3 simple steps to see if you qualify for free diabetes medication from Novo Nordisk: 1) Complete the “For Patient”, “Patient Signature”, and “Date” sections on the application 2) Gather proof of income 3) Take application and proof of income to your health care provider to complete the Health Care Practitioner section of your appication.

Patients and care givers can also obtain more information and access to the program by calling the Novo Nordisk Patient Assistance Program toll free at 866-310-7549. Patients can also obtain information by visiting Cornerstones4Care.com.

If you are a healthcare professional and you want additional information about the Novo Nordisk Patient Assistance Program, have eligible patients who are not yet enrolled, or have patients who are enrolled and want additional information about their eligibility, please visit NovoMedLink.com.

Contact Information:

Cornerstones4Care™ Patient Assistance Program, Novo Nordisk Inc.,

Phone: (866) 310-7549

Fax: (866) 441-4190

How to Apply:

Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Remember not to send program applications to the PPA.

Eligibility:

Patient must be a legal US resident and must not have or qualify for any government prescription coverage such as Medicaid, Veteran's Administration or any state or local programs (with the exception of Medicare Part D) which cover the Novo Nordisk product requested. Patient cannot have nor qualify for any private prescription coverage such as an HMO or PPO.

Other information:

Approved patients will receive a 90-day supply of medication sent to the physician's office. A new application must be submitted with each request. Income documentation is only required annually.

Product(s) covered by program:

GlucaGen® Hypokit
Levemir®
NovoFine®
NovoFine® Disposable Needles
NovoFine® Disposable Needles 30G (100/box)
NovoLog® Mix 70/30 FlexPen™ (5x3 mL)
Novolin®
Prandin®
Victoza®