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I further consent that Novo Nordisk may perform an on-site audit of Novo Nordisk Diabetes Patient Assistance Program PAP records related to the applicant named above on this application. I understand that I am not eligible to seek reimbursement for any medication dispensed by the Novo Nordisk Diabetes PAP from any government program or third party insurer and will not apply any Novo Nordisk Diabetes PAP medication towards the applicant s True-Out-Of-Pocket TrOOP costs. Novo Nordisk Patient Assistance Program Reorder Request Fax 866 441-4190 Phone 866 310-7549 Check this box if this request is for a new product or dose change Applicant Information Patient s Name Date of Birth Patient ID Number if available / Patient s State Licensed Health Care Practitioner Information State License Number Expiration Date NPI Number Practitioner s Name - Order Information Product Name Max Dose Per Day in units Sig Needle Information Needle Type Needle Gauge check one 30G 32G Health Care Practitioner Dec....

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Contact support

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. If you need assistance with prescription costs, help may be available. Visit www.pparx.org or call 1-888-4PPA-NOW. Cornerstones4Care®, NovoCare®, and Ozempic® are registered trademarks of Novo Nordisk A/S.

For Novo Nordisk Product Inquiries: 1-800-727-6500. For information about our Diabetes Patient Assistance Program: 1-866-310-7549 8 AM to 8 PM ET Monday through Friday.

Novo Nordisk A/S is a Danish multinational pharmaceutical company headquartered in Bagsværd, Denmark, with production facilities in eight countries, and affiliates or offices in 5 countries.

Ozempic® Patient Assistance Program (PAP) | NovoCare® The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to people living with diabetes. The Patient Assistance Program provides medication at no cost to those who qualify.

Definition. Patient Assistance Programs (PAPs are programs created by pharmaceutical and medical supply manufacturers to help financially needy patients purchase necessary medications and supplies.

Be a US citizen or legal resident. Have a total household income at or below four times (400%) the federal poverty level (FPL). ... Be uninsured, or in the Medicare program.

Eligible commercially insured patients with coverage for Ozempic® pay as little as $25 for a 1-month or 3-month supply. Month is defined as 28 days. Maximum savings is $150 for 1-month or $450 for 3-month supply. Eligibility and restrictions apply.

Novo Nordisk is a company people should strongly consider working for. Great company, great pipeline, great benefits. Lots of changes in the healthcare industry, this industry is difficult but very rewarding. They keep the patient at the center of everything they do.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232