Do not share your Ozempic® pen with other people, even if the needle has been changed. You may give other people a serious infection, or get a serious infection from them.
Diabetes Savings Card Program
Novo Nordisk Savings Card
Eligibility and Restrictions:
In order to redeem this offer, patient must have a valid prescription for the brand being filled. A valid Prescriber ID# is required on the prescription. Patient is not eligible if he/she participates in or seeks reimbursement or submits a claim for reimbursement to any federal or state health care program with prescription drug coverage, such as Medicaid, Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program (each a Government Program), or where prohibited by law. Patient must be enrolled in, and must seek reimbursement from or submit a claim for reimbursement to, a commercial insurance plan. The brand and the prescription being filled must be covered by the patient’s commercial insurance plan. Offer excludes full cash-paying patients. This offer may not be redeemed for cash. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described herein and will not seek reimbursement for any benefit received through this card. Novo Nordisk’s Eligibility and Restrictions, and Offer Details may change from time to time, and for the most recent version, please visit this webpage. Re-confirmation of information may be requested periodically to ensure accuracy of data and compliance with terms. Patients with questions about the Savings Card offer may call 1-877-304-6855.
This offer is valid in the United States and may be redeemed at participating retail pharmacies. Availability of the Savings Offer in Massachusetts will be dependent upon state law in effect at the time patient presents the Savings Offer when paying for the covered medications.
This offer is not transferable and is limited to one offer per person. Not valid if reproduced.
Cash Discount Cards and other non-insurance plans are not valid as primary insurance under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. This Savings Card cannot be combined with any coupon, certificate, voucher, or similar offer.
Patient is responsible for complying with any insurance carrier co-payment disclosure requirements, including disclosing any savings received from this program. It is illegal to (or offer to) sell, purchase, or trade this offer.
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.
Offer Details:
This offer is good for eligible patients purchasing up to a 90-day supply.
(a) NOVOLOG® (insulin aspart injection) 100 U/mL, NOVOLOG® MIX 70/30 (insulin aspart protamine and insulin aspart injectable suspension) 100 U/mL or VICTOZA® (liraglutide) injection 1.2 mg or 1.8 mg: Pay as little as (“PALA”) $25 per 30-day, $50 per 60-day, or $75 per 90-day supply for the first brand for up to 24 months from the date of Savings Card activation, subject to a maximum savings of $100 per 30-day (“Savings Benefit”), $200 per 60-day, or $300 per 90-day supply.
(b) FIASP® (insulin aspart injection) 100 U/mL: Pay as little as (“PALA”) $25 per 30-day, $50 per 60-day, or $75 per 90-day supply for up to 24 months from the date of Savings Card activation, subject to a maximum savings of $150 per 30-day, $300 per 60-day, or $450 per 90-day supply.
Get 1 free box of Novo Nordisk needles when you activate your Savings Card and enroll in the program. Limit 1 box of needles per person and maximum savings of $60. Needles are sold separately, will need a prescription, and need to be processed by a pharmacist. Needles must not be shared.
(c) OZEMPIC® (semaglutide) injection 0.5 mg or 1 mg: Pay as little as (“PALA”) $25 per 1-month prescription, $50 per 2-month prescription, or $25 per 3-month prescription for up to 24 months from the date of Savings Card activation, subject to a maximum savings of $150 per 1-month prescription, $300 per 2-month prescription, $450 per 3-month prescription. Month is defined as 28 days. In order to obtain the “PALA $25 per 3-month prescription” offer, the patient must have a prescription for a 3-month supply, and the patient’s commercial insurance plan must provide coverage for a 3-month fill.
(d) RYBELSUS® (semaglutide) tablets 3 mg, 7 mg, or 14 mg: Pay as little as (“PALA”) $10 per 30-day supply, $20 per 60-day supply, or $30 per 90-day supply for up to 24 months from the activation date, subject to a maximum savings of $300 per a 30-day supply, $600 per 60-day supply or $900 per 90-day supply.
Pharmacist:
When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any Government Program for this prescription, or where prohibited by law. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the eligibility criteria, and terms and conditions described herein. You also certify that you will not seek reimbursement for any benefit received through this card.
Pharmacist instructions for a patient with an Eligible Third Party:
Submit the claim to the primary Third Party Payer first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB [coordination of benefits] with patient responsibility amount and a valid Other Coverage Code, (eg, 8). The patient is responsible initially for the PALA amount and the card pays up to the Savings Benefit. Offer excludes full cash-paying patients. Reimbursement will be received from CHANGE HEALTHCARE. For any questions regarding CHANGE HEALTHCARE online processing, please call the Help Desk at 1–800–433–4893.
Do not share your Ozempic® pen with other people, even if the needle has been changed. You may give other people a serious infection, or get a serious infection from them.
Ozempic® may cause serious side effects, including:
Ozempic® (semaglutide) injection 0.5 mg or 1 mg is an injectable prescription medicine used:
It is not known if Ozempic® can be used in people who have had pancreatitis.
Ozempic® is not a substitute for insulin and is not for use in people with type 1 diabetes or people with diabetic ketoacidosis.
It is not known if Ozempic® is safe and effective for use in children under 18 years of age.
Do not share your Ozempic® pen with other people, even if the needle has been changed. You may give other people a serious infection, or get a serious infection from them.
Ozempic® may cause serious side effects, including:
Do not use Ozempic® if:
Before using Ozempic®, tell your health care provider if you have any other medical conditions, including if you:
Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements, and other medicines to treat diabetes, including insulin or sulfonylureas.
Ozempic® may cause serious side effects, including:
The most common side effects of Ozempic® may include nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation.
Please click here for Prescribing Information and Medication Guide for Ozempic®.
Ozempic® is a prescription medication.
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.
Do not use Rybelsus® if:
Rybelsus® (semaglutide) tablets 7 mg or 14 mg is a prescription medicine for adults with type 2 diabetes that along with diet and exercise may improve blood sugar (glucose).
Do not use Rybelsus® if:
Before using Rybelsus®, tell your healthcare provider if you have any other medical conditions, including if you:
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Rybelsus® may affect the way some medicines work and some medicines may affect the way Rybelsus® works.
Rybelsus® may cause serious side effects, including:
The most common side effects of Rybelsus® may include nausea, stomach (abdominal) pain, diarrhea, decreased appetite, vomiting, and constipation. Nausea, vomiting, and diarrhea are most common when you first start Rybelsus®.
Please see Prescribing Information and Medication Guide for Rybelsus®.
Rybelsus® is a prescription medication.
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.
What is the most important information I should know about Victoza®?
Victoza® may cause serious side effects, including:
Do not use Victoza® if:
Victoza® (liraglutide) injection 1.2 mg or 1.8 mg is an injectable prescription medicine used:
Victoza® is not for use in people with type 1 diabetes. It should not be used with other medicines that contain liraglutide. It is not known if Victoza® is safe and effective to lower blood sugar in children under 10 years of age.
Victoza® may cause serious side effects, including:
Do not use Victoza® if:
Before using Victoza®, tell your health care provider if you:
Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements, and other medicines to treat diabetes, including insulin or sulfonylureas.
The most common side effects of Victoza® may include nausea, diarrhea, vomiting, decreased appetite, indigestion, and constipation.
Please click here for Prescribing Information and Medication Guide for Victoza®.
Victoza® is a prescription medication.
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.
Do not share your Fiasp® with other people, even if the needle has been changed. You may give other people a serious infection, or get a serious infection from them.
Do not take Fiasp® if:
Before taking Fiasp® tell your health care provider about all your medical conditions including, if you:
Talk to your health care provider about low blood sugar and how to manage it.
Do not share your Fiasp® with other people, even if the needle has been changed. You may give other people a serious infection, or get a serious infection from them.
Do not take Fiasp® if:
Before taking Fiasp® tell your health care provider about all your medical conditions including, if you:
Talk to your health care provider about low blood sugar and how to manage it.
Change (rotate) your injection sites within the area you choose with each injection to reduce your risk of getting pits in skin or thickened skin (lipodystrophy) and skin with lumps (localized cutaneous amyloidosis) at the injection sites.
Your insulin dose may need to change because of:
Common side effects of Fiasp® may include:
Please click here for Fiasp® Prescribing Information.
Fiasp® is a prescription medication.
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.
Do not share your NovoLog® FlexPen®, NovoLog® FlexTouch®, PenFill® cartridge or PenFill® cartridge compatible insulin delivery device with other people, even if the needle has been changed. You may give other people a serious infection, or get a serious infection from them.
Do not take NovoLog® if:
Do not share your NovoLog® FlexPen®, NovoLog® FlexTouch®, PenFill® cartridge or PenFill® cartridge compatible insulin delivery device with other people, even if the needle has been changed. You may give other people a serious infection, or get a serious infection from them.
Do not take NovoLog® if:
Before taking NovoLog®, tell your health care provider about all your medical conditions including, if you are:
Talk to your health care provider about how to manage low blood sugar.
Serious side effects can lead to death, including:
Low blood sugar. Some signs and symptoms include:
Your insulin dose may need to change because of:
Other common side effects may include:
Get emergency medical help if you have:
Do not share your NovoLog® Mix 70/30 FlexPen® with other people, even if the needle has been changed. Do not share needles or syringes with another person. You may give other people a serious infection, or get a serious infection from them.
Before taking NovoLog® Mix 70/30, tell your healthcare provider about all your medical conditions including, if you are:
Talk to your health care provider about how to manage low blood sugar.
Do not share your NovoLog® Mix 70/30 FlexPen® with other people, even if the needle has been changed. Do not share needles or syringes with another person. You may give other people a serious infection, or get a serious infection from them.
Before taking NovoLog® Mix 70/30, tell your healthcare provider about all your medical conditions including, if you are:
Talk to your health care provider about how to manage low blood sugar.
Serious side effects can lead to death, including:
Low blood sugar. Some signs and symptoms include:
Your insulin dose may need to change because of:
Other common side effects may include:
Get emergency medical help if you have:
NovoLog® Mix 70/30 is a prescription medication.
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.
Do not share your Tresiba® FlexTouch® with other people, even if the needle has been changed. Do not share needles or syringes with another person. You may give other people a serious infection, or get a serious infection from them.
Do not take Tresiba® if you:
Before taking Tresiba®, tell your health care provider about all your medical conditions, including if you are:
Talk to your health care provider about low blood sugar and how to manage it.
Do not share your Tresiba® FlexTouch® with other people, even if the needle has been changed. Do not share needles or syringes with another person. You may give other people a serious infection, or get a serious infection from them.
Do not take Tresiba® if you:
Before taking Tresiba®, tell your health care provider about all your medical conditions, including if you are:
Talk to your health care provider about low blood sugar and how to manage it.
Tresiba® may cause serious side effects that can be life-threatening, including:
Your insulin dose may need to change because of change in level of physical activity or exercise, increased stress, change in diet, weight gain or loss, or illness.
Common side effects may include reactions at the injection site, itching, rash, serious allergic reactions (whole body reactions), skin thickening or pits at the injection site (lipodystrophy), weight gain, and swelling of your hands and feet.
Get emergency medical help if you have trouble breathing, shortness of breath, fast heartbeat, swelling of your face, tongue, or throat, sweating, extreme drowsiness, dizziness, or confusion.
Fiasp®, NovoCare®, NovoLog®, NovoLog® Mix 70/30, Ozempic®, Tresiba®, and Victoza® are registered trademarks of Novo Nordisk A/S.
Novo Nordisk is a registered trademark of Novo Nordisk A/S.
All other trademarks, registered or unregistered, are the property of their respective owners.
© 2021 Novo Nordisk All rights reserved. US20NC00085 January 2021
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