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Program Details
NOVO NORDISK, INC.
Growth Hormone Patient Assistance Program
Norditropin NordiFlex Injection 30mg
(somatropin (rDNA origin) )
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| CONTACT
INFO |
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| Address: |
, |
| Phone: |
1-888-668-6444 |
Provider Phone: |
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| Fax: |
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Website: |
Program Website |
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| ELIGIBILITY
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| Eligibility
Info: |
To qualify, patients must demonstrate financial need and must have attempted to find alternative reimbursement. Several factors are considered in evaluating financial need, including cost of living, size of household, and burden of total medical expenses.
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| Income at or below: |
Not
Published |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security requested on form: |
Not
Published |
| US citizenship/residency specified:
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Yes |
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|
APPLICATION |
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| Attachments
Required: |
Not Published
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Physician
License #
Required: |
Not Published
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Prescriber
Signature
Allowed: |
Not Published
|
Application
may be
faxed: |
Not Published
|
Eligibility
determination
letter sent: |
Patient
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| MEDICATION |
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| Receives: |
Medication
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| Shipped To: |
Patient
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| Quantity in
Shipment: |
90 days
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| Delivery Time: |
0-1 week
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| Re-application
Policy: |
New application every 12 months
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| Refill Policy: |
Patient must contact program |
| Other Information: |
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Last Updated: 01/24/2025
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Application Forms
& Instructions
The following documents
are provided in interactive PDF format, allowing you to type information
directly into the form.
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