Apply to Novo Nordisk Patient Assistance Program

Free Novo Nordisk diabetes medicines (insulins, Ozempic for the uninsured) for people with limited income who are uninsured or, for insulin, on Medicare. Apply directly with the program; here is what it asks and what happens next.

Who can apply?

Yearly household income before taxes, 2026 limits
Medicines1 person2 people3 people4 people
Ozempic$31,920$43,280$54,640$66,000
Xultophy 100/3.6, Fiasp, Novolin R, Novolin N, Novolin 70/30
and 5 moreNovoLog, NovoLog Mix 70/30, Tresiba, NovoPen Echo, NovoFine 32G
$63,840$86,560$109,280$132,000

Uninsured: at or below 400% FPL for most products; Ozempic uninsured at or below 200% FPL. Medicare: insulins only, at or below 400% FPL. Page gives no dollar table (points to NeedyMeds).

Commercial insurance is not eligible. Medicare Part D patients can get Novo Nordisk insulins (not Ozempic) at or below 400% FPL; once enrolled they stay through the calendar year and agree not to get the drug through Part D or count it toward TrOOP. Applicant must not be enrolled in or eligible for Medicaid, Extra Help/LIS, other federal programs (except Part D) or VA drug benefits; denial letters required if eligible. Uninsured applicants with income within their state's Medicaid limits must send a Medicaid denial. The $1,000 out-of-pocket requirement for Part D was removed. TRICARE not named.

Then what?

  1. Sign

    • Medicare Part D enrollee consent (Part D only)
    • income verification consent (FCRA, soft credit check)
    • consent to collection of health information
    • HIPAA authorization
    • program authorization and certification
    • optional TCPA call/text consent
    • optional authorized representative designation

  2. Attach

    • Medicaid denial letter and/or Extra Help (LIS) denial letter if eligible for either
    • proof of income for applicant and household (pay stubs, W-2 or 1099) if you did not file taxes or had a life event changing income
    • photo government ID for Maine or Minnesota residents

  3. Your prescriber

    • completes and signs the prescriber section and declaration (handwritten or valid electronic signature; no stamps or photocopies)
    • lists products, sig and quantity (up to 120-day supply)
    • office email address is required on the online application
    • provides a prescription if approved

  4. Send

    • Fax 1-866-441-4190
    • Mail to Novo Nordisk, Inc., PO Box 370, Somerville, NJ 08876

Rather apply online? Apply on the Novo Nordisk Patient Assistance Program site.

Questions: call Novo Nordisk Patient Assistance Program at 1-866-310-7549. Uninsured: 12 months. Medicare: through end of calendar year; reapply after October 15 for next year. Renewals can be submitted 30 days before enrollment ends..

Free. "The Novo Nordisk PAP is free... no one affiliated with Novo Nordisk will ever ask you for payment." Patients are not required to use a third party who charges a fee. EveryCard Rx isn't paid by the program and never sends anything for you. Form , rules checked 2026-11-06 from the program's own pages. Something out of date? Tell us.