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Hormone Therapy Patient Assistance

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 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 applicant instructions below. If approved, a free 90-day supply of medicine will be sent to the prescribing physician’s office. Patients can pick up their medicine at their physician’s office at their convenience.

In order to apply for a free supply of Vagifem® (estradiol vaginal inserts) 10 mcg:

  1. Download the application form: Application
  2. Complete all the following sections according to the instructions: Patient information, eligibility, signatures, 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 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 documents should be submitted to Novo Nordisk by mail or fax:

Return by fax to: 1-888-868-9853

Return by mail to:
Novo Nordisk Patient Assistance Program
Hormone Therapy
PO Box 181640
Louisville, KY 40261

Please call Novo Nordisk at 1-888-868-9852 if you have questions.

 



Important Safety Information for Hormone Therapy Products


VAGIFEM® 10 MCG (estradiol vaginal inserts)

Indications and Usage:

Vagifem® (estradiol vaginal inserts) is used after menopause to treat menopausal changes in and around the vagina.

Important Safety Information:

What is the most important information I should know about VAGIFEM® (an estrogen hormone)?
  • Using estrogen-alone may increase your chance of getting cancer of the uterus (womb)
  • Report any unusual vaginal bleeding right away while you are using Vagifem®. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check unusual vaginal bleeding to find the cause.
  • Do not use estrogen-alone to prevent heart disease, heart attacks, strokes or dementia (decline of brain function)
  • Using estrogen-alone may increase your chances of getting strokes or blood clots
  • Using estrogen-alone may increase your chance of getting dementia, based on a study of women age 65 years or older
  • Do not use estrogens with progestins to prevent heart disease, heart attack, or dementia
  • Using estrogens with progestins may increase your chances of getting heart attacks, strokes, breast cancer, or blood clots
  • Using estrogens with progestin may increase your chance of getting dementia, based on a study of women 65 years and older
  • You and your healthcare provider should talk regularly about whether you still need treatment with Vagifem®

Do not start using Vagifem® if you currently have or have had certain cancers. Estrogens may increase the chances of getting certain types of cancers, including cancer of the breast or uterus. Also, do not start using Vagifem® if you have unusual vaginal bleeding, had a stroke or heart attack, currently have or have had blood clots, currently have or have had liver problems, have been diagnosed with a bleeding disorder, are allergic to Vagifem® or any of its ingredients, or think you may be pregnant.

Vagifem® is only used in the vagina; however, the risks associated with oral estrogens should be taken into account.

The most commonly reported side effects of Vagifem® included: headache, breast pain, irregular vaginal bleeding or spotting, stomach/abdominal cramps, bloating, nausea and vomiting, hair loss, fluid retention, and vaginal yeast infection.

Estrogens should be used at the lowest dose possible for your treatment only as long as needed.

Please click here (PDF) for Vagifem® Prescribing Information.

Vagifem® is a prescription medication.

Talk to your doctor to see if Vagifem® is right for you.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch , or call 1-800-FDA-1088.

Novo Nordisk provides patient assistance for those who qualify. Please call 1-866-310-7549 to learn more about Novo Nordisk assistance programs.




Vagifem® is a registered trademark of Novo Nordisk Health Care AG.
Novo Nordisk is a registered trademark of Novo Nordisk A/S.
Novo Nordisk Inc., 800 Scudders Mill Road, Plainsboro, New Jersey 08536 U.S.A.
© 2017 Novo Nordisk All rights reserved. USA17BIO00017 February 2017