If you're a patient 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 patient's home.
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
PO Box 181640
Louisville, KY 40261
Please call Novo Nordisk at 1-888-868-9852 if you have questions.