The Novo Nordisk Patient Assistance Program

Diabetics who lose their Cobra coverage will not be able to get insurance on their own because of this pre-existing condition. But with your physicians help they may qualify for free insulin and needles from Novo Nordisk. Included in this offer are the following brand names; FlexPen, GlucaGen, HypoKit, Levemir, Novolin, Novolog, NovoFine, and Victoza. If you need help paying for your insulin and are not on one of these formulations you should ask your doctor if it is possible to change your prescription to one that is covered.

If you are over 65

Medicare enrollees must have applied for and been denied the Low Income Subsidy (LIS) from the Social Security Administration (SSA) or hit the donut hole for the relevant benefit year before submitting the application for the Patient Assistance Program (PAP). To apply for LUS contact the SSA at 800-772-1213 or go to www.socialsecurity.gov/prescriptionhelp. Once denied you must attach a photocopy of the denial letter to the application for the PAP or you must be able to document from your Part D Plan that you have hit the donut hole by submitting your monthly statement of benefits or an explanation of benefits. If you do qualify for LIS you will not qualify for this program. If you believe you qualify then follow then continue to follow the instructions below.

If you are under 65

Your doctor is required to fill out their portion of the application and add a prescription for a three month supply of medication. They should include a prescription for needles. They must sign their part of the application

The patient must complete a very short one page application. A photo copy of your latest tax returns (1040), SSI income, pensions, interest, retirement funds, child support and any other sources of in income should be included in your submission. If you are on Social Security submit you "letter of award". If you have zero income and have not filed a tax return you can submit a letter from your doctor or a social agency on agency letterhead.

The application can be faxed but the fax must come from a doctor's office. The fax number is 866-441-4190. Or you can mail it to:

Novo Nordisk Patient Assistance Program
PO Box 18140
Louisville KY 40261

Both you and your doctor will receive notification of acceptance or denial.

What are the income requirements?

In the contiguous 48 states they are:

For a single person household - $21,660

For a two person household - $29,140

About $7,000 is added for each person up to seven and then $3,740 is added for each additional person more then 8.

Income documentation must be resubmitted yearly.

Though Wal-Mart has an excellent prescription program they do not offer insulin on their reduced drug list. But it is a very good source for many of your other prescription needs. Over 300 medications can cost as little as $4 a month or $10 for three months. So combining the Novo Nordisk Program with the Wal-Mart plan may be the way to go until the new healthcare bill goes into full swing.

http://www.novonordisk-us.com