Welcome to Novo Nordisk in the United States

Patient Assistance- Hormone Therapy


 

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®:

1) Download the application form:  English | Spanish

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):

1-866-441-4190
NOTE: Faxes must be sent from your physician’s office.

By mail (response time up to 17 days):

Novo Nordisk Patient Assistance Program
Hormone Therapy
P.O. Box 181640
Louisville, KY 40261

For questions, please call Novo Nordisk at 1-866-310-7549.

Additional Information:

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.