Patient assistance programs (PAPs) are programs created by drug companies, such as NOVO NORDISK, INC., to
offer free or low cost drugs to individuals who are unable to pay for their medication.  These Programs may also be
called indigent drug programs, charitable drug programs or medication assistance programs.  Most of the best
known and most prescribed drugs can be found in these programs.  All of the major drug companies have patient
assistance programs, although every company has different eligibility and application requirements.

The NOVO NORDISK, INC. patient assistance program offers free medication to people who otherwise cannot afford
their medications.  Patients must meet financial and other program specific criteria to be eligible for assistance.

Patient Assistance Program

The medications available through this program are:  

GlucaGen Hypokit (glucagon (rDNA) for injection)
Levemir (insulin detemir (rDNA) injection)
NovoFine 30G (insulin (rDNA))
Novolin 70/30 InnoLet (insulin (rDNA))
Novolin 70/30 Vials (insulin (rDNA))
Novolin N InnoLet (insulin (rDNA))
Novolin N Vials (70% NPH/30% regular human insulin (rDNA))
Novolin R InnoLet (insulin (rDNA))
Novolin R Vials (regular, human insulin injection (rDNA))
NovoLog (insulin analog injection)
NovoLog FlexPen (insulin analog injection)
NovoLog Mix 70/30 (insulin analog injection)
Prandin .5mg/1mg/2mg (repaglinide)


Eligibility:

Novo Nordisk Patient Assistance Program, a patient assistance program provided by Novo Nordisk Pharmaceuticals,
Inc., offers a three month supply of the medications listed to the right at no cost to those who are eligible for the
program. Eligibility is based off of the following requirements:

  • Your income must be less than or equal to 200% of the Federal Poverty Guideline for the size of your
    household (see chart below).

  • You must not be covered by private or public health insurance.

  • If you are eligible for Medicare, but did not enroll, then you are ineligible for this program.

  • The medication must be sent to the physicians office.

  • Those eligible for Medicare Part D but not enrolled may still be eligible.

SOURCE: 2008 Poverty Chart




















What’s Next?

Fill out the program enrollment form located below. After filling out the enrollment form please bring the form to your
doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your
application to the program.

Novo Nordisk Patient Assistance Enrollment Form

Novo Nordisk Patient Assistance Enrollment Form Instructions


Please click here to go to the program website for more information
Family Size
 100%
 133%
 150%
 200%
 250%
 300%
1
 $10,400
 $13,382
 $15,600
 $20,800
 $26,000
 $31,200
2
 $14,000
 $18,620
 $21,000
 $28,000
 $35,000
 $42,000
3
 $17,600
 $23,408
 $26,400
 $35,200
 $44,000
 $52,800
4
 $21,200
 $28,196
 $31,800
 $42,400
 $53,000
 $63,000
5
 $24,800
 $32,984
 $37,000
 $49,600
 $62,000
 $74,400
6
 $28,400
 $37,772
 $42,600
 $56,800
 $71,000
 $85,200
7
 $32,000
 $42,560
 $48,000
 $64,000
 $80,000
 $96,000
8
 $35,600
 $47,348
 $48,000
 $64,000
 $80,000
 106,800
For each
additional
family member
$3,600
$4,788
$5,400
$7,200
$9,000
$10,800