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  1. The Patient Assistance Program provides medication at no cost to those who qualify. Patients who are approved for the PAP may qualify to receive free medicine from Novo Nordisk. There is no registration charge or monthly fee for participating.

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  2. The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to people living with diabetes. The Novo Nordisk PAP provides medication at no cost to those who qualify. There is no registration charge or monthly fee for participating.

  3. The Novo Nordisk Diabetes Patient Assistance Program (PAP) provides medication to qualifying applicants at no charge. If the applicant qualifies under the Novo Nordisk Diabetes PAP guidelines,

  4. Novartis Patient Assistance Foundation (NPAF) provides Novartis medication free of cost to eligible patients without insurance coverage or who cannot afford the cost of the medication.

  5. AbbVie can start assessing you for eligibility of Patient Access Support programs when pages 4 and 5 of this form and required documentation are submitted by you and your prescriber’s office in one of the following ways:

  6. To be eligible, a patient must: • Reside in the United States or a U.S. Territory • Have limited or no prescription insurance coverage • Meet income guidelines for the medication for which the patient is seeking assistance. Visit www.PAP.Novartis.com • Have a valid prescription for the Novartis medication

  7. Instructions: Health Care Practitioner Information Section must be filled out completely. Patient Information and Eligibility Section must be filled out completely. Attach the completed product request form for a 90-day supply of medication for all products except where indicated differently (see official program application)

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