Novo Nordisk Patient Assistance Program

Information last checked September 24, 2026

Contact info

Enroll Online
Patient must not have insurance, or is enrolled in Medicare.
Patient cannot be enrolled in or qualify for any other federal, state, or government program such as Medicaid, Low Income Subsidy, or Veterans (VA) Benefits (with the exception of Medicare Part D).
Program also provides co-pay assistance.

Income limit, single: 400% of the federal poverty level
Income limit, couple: 400% of the federal poverty level
Other income rules: Note: For Ozempic - Total household income must be at or below 200% of the Federal Poverty Level.
Medical expenses can be deducted: Not published
Social Security number asked for: Yes
US citizenship or residency required: Yes

Documents to attach: Proof of income
Medicaid denial letter
Medicare Part D enrollees must also sign the Medicare Part D certification
Prescriber license number: NPI number
State license number
Who can sign: Physician
Application can be faxed: Yes
Decision letter sent to: Provider and patient

Patient receives: Medication
Shipped to: Patient
Supply per shipment: Up to 120-day supply
Time to first delivery: 0–2 weeks
Refills: A reorder form must be submitted
Staying enrolled: New application every 12 months
New proof of income every 12 months

Eligibility

Enroll Online
Patient must not have insurance, or is enrolled in Medicare.
Patient cannot be enrolled in or qualify for any other federal, state, or government program such as Medicaid, Low Income Subsidy, or Veterans (VA) Benefits (with the exception of Medicare Part D).
Program also provides co-pay assistance.

Income limit, single

400% of the federal poverty level

Income limit, couple

400% of the federal poverty level

Other income rules

Note: For Ozempic - Total household income must be at or below 200% of the Federal Poverty Level.

Medical expenses can be deducted

Not published

Social Security number asked for

Yes

US citizenship or residency required

Yes

Medications covered

Fiasp (insulin aspart injection)

NovoFine 30G (needles)

NovoFine Plus 32G (needles)

Novolin 70/30 Vials (insulin (rDNA))

Novolin N Vials (70% NPH/30% regular human insulin (rDNA))

Novolin R Vials (regular, human insulin injection (rDNA))

NovoLog (insulin analog injection)

NovoLog Mix 70/30 (insulin analog injection)

Ozempic (semaglutide)

Tresiba (insulin degludec injection)