To be reimbursed for OOP expenses associated with NIT for CLD under the NovoDETECT^® Liver Disease Testing Support Program, the patient must enroll and be accepted as eligible.  This program is only available to commercially or privately insured patients whose healthcare provider has ordered a non-invasive test covered under CPT codes 81517, 76981, or 91200 for the purposes of screening for CLD, including MASH. Eligible patients are reimbursed for their copayment or out-of-pocket expenses directly incurred for non-invasive testing under the Program.  Patient cost-share obligations for office visits are not reimbursable under the Program. All program payments are for the benefit of the patient only.

A patient is not eligible for the Program if he/she is enrolled in any federal or state health care program, such as Medicaid, Medicare, VA, DOD, TRICARE, or any similar federal or state health care program (each a Government Program), or where prohibited by law.  Patients enrolled in federal or state health care program may not use this program even if they elect to not use their insurance benefits.  Note:  The Federal Employees Health Benefits (FEHB) Program, Affordable Care (Health Exchange) Plans, and insurance provided through state employee plans are NOT federal or state government healthcare programs for purposes of this savings offer. Patient must be enrolled in a commercial insurance plan.  This program is not valid for uninsured patients. 

This reimbursement program is valid only in the United States and its territories, unless prohibited by law. Program is not transferable and is limited to one offer per person. Not valid if reproduced.

Novo Nordisk’s Eligibility and Restrictions, and Reimbursement Details may change from time to time, and for the most recent version, please visit this webpage. Re-confirmation of patient information may be requested periodically to ensure accuracy of data and compliance with terms. Patients with questions about the Offer may call 1-833-747-4004 (available Monday – Friday 8am – 8pm ET, excluding holidays).

Participating patients are responsible for providing Novo Nordisk with accurate information necessary to determine program eligibility. Payment of the reimbursement is subject to verification by Novo Nordisk in its sole discretion, as well as all the Terms and Conditions of the Program.

• The NovoDETECT^® Liver Disease Testing Support Program may help lower your non-invasive test out-of-pocket costs. With the offer, eligible patients may pay as little as $25 per test, with a maximum annual savings benefit of $3,000
• Annual savings benefit will reset every January 1^st until program expiration
• Patients are responsible for all amounts that exceed this limit.
• Out-of-pocket expenses covered by the Program include co-payment, co-insurance, and deductible out-of-pocket costs for the eligible patient's non-invasive test.
• The Program does not cover any other costs such as those related to patient office visits or other related procedures.
• Reimbursement is issued to the patient and is contingent on the submission of the required Explanation of Benefits (EOB) and receipt(s) showing valid payment to the lab or provider by the patient of their out-of-pocket obligations.  Please note that we are unable to approve payments directly to lab/HCPs.
• The Program may apply to patient out-of-pocket costs incurred for an eligible non-invasive test 90 days prior to the start date of the patient's enrollment, subject to the program maximum annual savings and the applicable Terms and Conditions based on test administration date. Patient may contact customer service at 1-833-747-4004 for more information.

The EOB must:

• list the patient's name and date of service for the NIT for CLD testing authorized by

CPT (current procedural terminology) codes of 81517; 76981;or 91200); and,

• list the date of service for the non-invasive test as no later than April 30, 2026; and
• be submitted to the program by the patient within 180 days of the date of service and never later than 10/31/26; and,
• list the itemized patient out-of-pocket cost for the non-invasive test that is not covered by their insurance – this is the patient's portion of the payment for the non-invasive test; and, be submitted with valid verification of payment to:

By mail
NovoDETECT^® Liver Disease Testing Support Program
PO Box 1326
Morristown, NJ 07962

Uploaded to the patient portal: www.livertestingsupport.com

Valid Verification of Payment/Bill Showing Payment Due – WITH THE EOB, the patient must submit:

• The receipt/invoice/bill from the laboratory that conducted the non-invasive test that specifically lists the patient's name, address, and service date for the non-invasive test (note the service date must match the date listed on the valid EOB and must be on or before [April 30, 2026]) and the out-of-pocket amount owed to the laboratory once the patient's insurance has covered its portion in full; and, ONE OF THE FOLLOWING:
• Receipt/paid invoice/paid bill from the laboratory that shows the patient has paid in full their portion of their out-of-pocket cost for the non-invasive test.

OR

• A cancelled check or credit card statement/receipt paid to the laboratory evidencing the patient's paid portion of their out-of-pocket cost for the non-invasive test.

Limitation of Third-Party Reimbursement:

• Patients may not seek reimbursement for the value received from the NovoDETECT^® Liver Disease Testing Support Program from any third-party payers, including a flexible spending account or healthcare savings account. Participating in this program means that you are ensuring you comply with any required disclosure your insurance provider may have regarding your participation in the NovoDETECT^® Liver Disease Testing Support Program. Novo Nordisk intends that all savings from this offer accrues to the patient and is intended to be credited towards patient out-of-pocket obligations and maximums, including applicable co-payments, coinsurance, and deductibles. Some insurance plans have established programs that require you to enroll in a manufacturer copay assistance program, including:
  • Programs in which payments made by you that are subsidized by testing manufacturer company savings offer programs do not count towards your deductibles or other patient out-of-pocket cost sharing amounts (e.g., accumulator adjustment programs); and/or
  • Programs that adjust patient out-of-pocket cost sharing amounts based on the availability of a testing manufacturer savings offer (e.g., maximizer programs)

• Except where prohibited by law, if your insurer has implemented these types of programs, you will not be eligible for and agree not to use this savings program, and Novo Nordisk reserves the right to reduce or discontinue financial assistance under this savings program, including, but not limited to, reducing your per claim maximum savings benefit and/or your annual maximum savings benefit.  If you learn that your insurance company or health plan has implemented either an accumulator adjustment program or a co-pay maximizer program, you agree to inform Novo Nordisk.  Since you may be unaware whether you are subject to an accumulator adjustment or co-pay maximizer program when you enroll in the Novo Nordisk savings program, Novo Nordisk will monitor program utilization data and reserves the right to reduce, discontinue, or otherwise modify this savings offer at any time, and with or without notice.

The NovoDETECT^® Liver Disease Testing Support Program is not health insurance. This program is managed by ConnectiveRx on behalf of Novo Nordisk. The parties reserve the right to rescind, revoke, or amend this offer without notice at any time.

This offer is effective through 4/30/2026 and only covers tests completed on or before 4/30/26. Submissions for reimbursement must be received no later than 10/31/26.