Don't qualify for this program?
Visit the DBAs to look for financial assistance based on your diagnosis.

Updated April 17, 2014
NovoLog FlexPen

Novo Nordisk Patient Assistance Program

Provided by: Novo Nordisk Pharmaceuticals, Inc.

PO Box 370
Sumerville, NJ 08876

TEL: 866-310-7549


ALT PHONE: 609-987-5800
FAX: 866-441-4190
Languages Spoken:

English, Spanish

Program Website
 

Patient Assistance Applications

Novo Nordisk Patient Assistance Program

 

Medications

  • NovoLog FlexPen Injection (5x3mL) 100 units mL (insulin aspart (rDNA))
 

Eligibility Requirements

Insurance Status Must be uninsured
Those with Part D Eligible? Yes, if in the donut hole
Income At or below 200% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Medications sent if accepted. If denied patient and Doctor notified
Decision Timeframe 5-7 business days
   

Medication

Amount/Supply Up to 120 day supply
Sent To Doctor's office or pharmacy
Delivery Time Within 2 business days
Refill Process Reorder form needs to be submitted
Limit Not specified
Re-application New application, new documentation yearly
   

Additional Information