The Novo Nordisk Hormone Therapy Patient Assistance Program (PAP) embodies our commitment to our patients and the Novo Nordisk Triple Bottom Line. The Hormone Therapy Patient Assistance Program provides free medicine to those who need it.
If you are a patient in need of assistance or know someone in need of assistance, please see the application instructions below. If approved, a free 5-month supply of medicine will be sent to the prescribing physician's office. The physician will be contacted to approve necessary refills in 5 months. Patients can pick up their medicine at their physician's office at their convenience. Patients will receive their medication this way for as long as they qualify.
However, you must reapply every year.
In order to apply for a free supply of Activella® 0.5 mg/0.1 mg or Vagifem®:
2) Complete the following sections according to the instructions: Patient information, eligibility, signature, and date.
3) Gather proof of income. Examples include a Federal tax return (1040), social security benefit forms (SSA1099), pension interest, retirement benefits, child support, or other sources.
4) Give it to your health care professional so that he/she can fill out the practitioner and prescribing sections as well as sign and date the application.
Once completed, the form and any necessary attachments should be submitted to Novo Nordisk by mail or fax using the contact information provided below:
By fax (response time up to 10 days):
NOTE: Faxes must be sent from your physician’s office.
By mail (response time up to 17 days):
Novo Nordisk Patient Assistance Program
P.O. Box 181640
Louisville, KY 40261
For questions, please call Novo Nordisk at 1-866-310-7549.
One Activella® tablet should be taken once daily. For this program, Activella® 0.5 mg/0.1 mg is available in a 5-pack of 28 tablets, providing 5 months of therapy.
Vagifem® tablets are inserted vaginally, once daily for the first 2 weeks, then one tablet is inserted twice weekly for as long as therapy is required. The need to continue therapy should be discussed with the physician at each visit. Each Vagifem® tablet is contained in a disposable, single-use applicator, packaged in a blister pack. Cartons contain 18 doses (for the initial month) or 8 doses (for all following months). As with Activella®, 5 months of therapy will be sent at one time to your physician's office.
Estrogens have important benefits but also some risks. Patients must decide, with their physician or health care professional, whether the risks of estrogen use are acceptable to them because of the benefits.
If you are a patient that uses estrogens, check with your health care provider to be sure you are using the dose that is appropriate for you and that you don’t use them longer than necessary. How long you need to use estrogens should be decided by you and your health care professional.
If you are a health care professional seeking additional information about the Novo Nordisk Hormone Therapy Patient Assistance Program, have eligible patients who are not yet enrolled, or have patients who are enrolled and you are seeking additional information about their eligibility, please visit the "For Patients & Office" section on the Physician Portal at NovoMedLink.com.
Activella® and Vagifem® are registered trademarks of Novo Nordisk FemCare AG.
ACTIVELLA® 0.5 mg/0.1 mg and ACTIVELLA® 1.0 mg/0.5 mg
Activella® 0.5 mg/0.1 mg (estradiol/norethindrone acetate) tablets is used after menopause in women who have a uterus to reduce moderate to severe hot flashes, and to help reduce your chances of suffering from osteoporosis (thin weak bones). If you use Activella® only to prevent osteoporosis, talk to your health care provider about whether a different treatment or medicine without estrogens might be better for you.
Important Safety Information:
WHAT SHOULD KNOW ABOUT Activella®?
First of all, Activella® isa combination of estrogen and progestin hormones.
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes. Using estrogens with or without progestins may increase your chance of getting heart attacks, strokes, breast cancer, and blood clots.
Do not use estrogens with or without progestins to prevent dementia. Using estrogens with or without progestins may increase your risk of dementia.
You and your health care provider should talk regularly about whether you still need treatment with Activella®.
Do not take Activella® if you have had your uterus removed (hysterectomy). Do not start taking Activella® if you have unusual vaginal bleeding, currently have or have had certain cancers (including cancer of the breast or uterus), had a stroke or heart attack in the past year, currently have or have had blood clots, currently have or have had liver problems, are allergic to Activella® or any of its ingredients, think you may be pregnant, or are breast feeding.
In woman with a uterus, the use of estrogen alone may increase the chance of getting cancer of the tissue lining the uterus. You should contact your doctor right away if you have unusual vaginal bleeding.
In a clinical trial, the most commonly reported adverse events (reported at a frequency of ≥5%) were back pain, pain in arms and legs, headache, nausea, diarrhea, upper respiratory tract infection, uterine thickening and vaginal bleeding.
Estrogens and progestins should be used at the lowest dose possible for your treatment and only as long as needed.
Vagifem® (estradiol) vaginal tablet is indicated for the treatment of atrophic vaginitis.
Important Safety Information:
ESTROGENS HAVE BEEN REPORTED TO INCREASE THE RISK OF ENDOMETRIAL CARCINOMA (cancer of the uterus).
Vagifem® should not be used by women who are pregnant or who think they may be pregnant. It should not be used immediately after childbirth or while breast-feeding. It also should not be used by women who have unusual vaginal bleeding, a history of breast or uterine cancer, or a history of blood clots.
Vagifem® may cause some side effects that are generally mild. Those commonly reported in clinical studies include headache, abdominal pain, back pain, upper respiratory tract infection, vaginal itching, and vaginal yeast infection. Vagifem® is designed to work only where it is applied in the vagina, and has not been shown to have a significant effect on other organs or tissues (such as the breasts or bones). If you experience side effects while taking Vagifem®, be sure to tell your doctor.
Remember to check with your doctor to make sure Vagifem® or any other hormone product is right for you.
Headquartered in Denmark, Novo Nordisk is a global health care company with 90 years of innovation and leadership in diabetes care. The company also has leading positions within hemophilia care, growth hormone therapy, and hormone therapy.
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