Novo Nordisk
NovoCare Patient Assistance Program
Free medication shipped to your prescriber
Income cap
400% FPL
Processing
~10 days
Approval period
12 months
Phone
1-866-310-7549
Must be uninsured
US citizen or legal resident
⚠Medicare Part D excluded
⚠Medicaid recipients excluded
Application steps
- 1.Confirm your annual household income is at or below 400% of the Federal Poverty Level
- 2.Confirm you are a US citizen or legal resident
- 3.Download the patient + prescriber forms from NovoCare
- 4.Complete the patient section (income, household, insurance status)
- 5.Have your prescriber complete and sign the medical section
- 6.Fax or mail the completed application to NovoCare
- 7.Allow up to 10 business days for an eligibility decision
Documents needed
- •Most recent federal tax return (1040) OR two most recent pay stubs
- •Proof of US citizenship or legal residency
- •Prescriber signature on application
- •Medicare denial letter if age 65+ (proves no Part D coverage)
Approval covers 12 months of medication shipped directly to the prescribing clinic. Re-apply annually. Patients enrolled in Medicare, Medicaid, or any commercial insurance with prescription benefits are NOT eligible.
Source: www.novocare.com · Last verified 2026-06-03