NeedyMeds

This program provides brand name medications at no or low cost.

Novo Nordisk Diabetes Patient Assistance Program

Provided by:

Novo Nordisk Pharmaceuticals, Inc.

PO Box 181640 Louisville, KY 40261 TEL: 866-310-7549 opt 3 ALT PHONE: 609-987-5800 FAX: 866-441-4190	Program Website

	Languages Spoken: English, Spanish

Patient assistance
applications

Medications

NovoLog FlexPen Injection (insulin aspart rDNA origin)

Eligibility Requirements

APPLICATION

MEDICATION

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

Obtaining	Call or download
Receiving	Faxed or mailed
Returning	Mail or fax
Doctor's Action	Complete section, sign
Applicant's Action	Complete section, sign, attach proof of income
Decision Communicated	Medications sent if accepted. If denied patient and Doctor notified
Decision Timeframe	7-10 business days

Amount/Supply	Up to 90 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:

Patient Assistance Program questions are provided by Cornerstones4Care.