PATIENT HELP

Hormone therapy patient resources

The Novo Nordisk Hormone Therapy Patient Assistance Program (PAP) embodies our commitment to our patients and helps provide medicine to those who need it. If you are 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 your home.

To apply:

  • Download the application here. 
  • Complete all the following sections according to the instructions: Patient information, eligibility, signatures, and date.
  • Gather proof of income including a Federal Tax Return (1040), Social Security Benefit Form (SSA1099), pension interest, retirement benefits, child support, or other sources.
  • Give it to your healthcare professional so they can complete the practitioner and prescribing sections, as well as sign and date the application.

 

Submit your form:

Once completed, the form and any necessary documents should be submitted to Novo Nordisk by mail or fax.

Return by fax to: 
1-888-868-9852

Return by mail to:

Novo Nordisk Patient Assistance Program
Hormone Therapy
PO Box 7613 
Overland Park, KS 66207

If you have further questions, please call us at 1-888-868-9852.