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

NovoLog FlexPen

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Novo Nordisk Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Novo Nordisk Pharmaceuticals, Inc.

PO Box 370
Somerville, NJ 08876

TEL: 866-310-7549


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

English, Spanish

Program Website

 

Program Applications and Forms

Novo Nordisk Patient Assistance Program Application

Novo Nordisk Patient Assistance Program Application (Spanish)

 

Medications

  • NovoLog FlexPen 3 ml/pen (insulin aspart recombinant)
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? Contact program for details.
Income At or below 400% 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 Fax or mail from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Medications sent if accepted. If denied patient and doctor notified
Decision Timeframe 7-10 business days
   

Medication

Amount/Supply Up to 120 day supply
Sent To Doctor's office
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

This program also provides copay assistance.

Updated July 02, 2019