Novo Nordisk Hormone Therapy Patient Assistance Program
Novo Nordisk
Contact Information
Novo Nordisk Patient Assistance Program
PO Box 181640
Louisville, KY 40261
1-(866) 668-6336 (phone)
Novo Nordisk Patient Assistance Program
PO Box 181640
Louisville, KY 40261
1-(866) 668-6336 (phone)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
Eligibility:
Patient cannot have or qualify for any government prescription coverage such as Medicare, Medicaid, Veteran's Administration or any state or local programs. Patient cannot have or qualify for any private prescription coverage such as an HMO or PPO. Patient's total household income must be at or below 200% of the Federal Poverty Level.
Patient cannot have or qualify for any government prescription coverage such as Medicare, Medicaid, Veteran's Administration or any state or local programs. Patient cannot have or qualify for any private prescription coverage such as an HMO or PPO. Patient's total household income must be at or below 200% of the Federal Poverty Level.
Other Information:
Approved patients will receive a five month supply of medication sent to the physician's office. A new application must be submitted for a second request. A maximum of 2 requests will be granted to approved patients.
Approved patients will receive a five month supply of medication sent to the physician's office. A new application must be submitted for a second request. A maximum of 2 requests will be granted to approved patients.
Product(s) covered by program:
- Activella® 0.5mg/0.1mg
- Activella® 1.0mg/0.5mg
- Vagifem®
- Vagifem® 18
- Vagifem® 8
