Activella

Indicated For

menopause vasomotor symptoms, vulvar vaginal atrophy, postmenopausal osteoporosis

About This Medication

# Novo Nordisk Hormone Therapy Patient Assistance Program Patient Guide: How to Get Activella (estradiol norethindrone) at Low or No Cost This guide explains how to apply for free Activella through the Novo Nordisk Hormone Therapy Patient Assistance Program (PAP). It covers eligibility, steps, and tips for success in simple terms.[1][2] ## About Activella and Why This Program Helps **Activella** is a prescription hormone replacement therapy combining estradiol and norethindrone. It treats moderate to severe menopausal symptoms like hot flashes, night sweats, and vaginal dryness by replenishing hormones that decrease during menopause. It also helps prevent postmenopausal osteoporosis (bone thinning).[1] High costs can make Activella hard to afford without insurance. The Novo Nordisk PAP provides it **free** for up to one year to eligible patients who are uninsured or underinsured and meet income limits. No enrollment fees or monthly charges apply. Approved patients get up to a **90-day supply** shipped to their doctor's office.[1][2][3][4] ## Who Qualifies? To qualify, you must: - Be a **U.S. citizen or legal resident** with a valid Social Security Number.[4][6] - Have **no or limited prescription insurance** (uninsured or underinsured; Medicare Part D patients are now eligible without the prior $1,000 out-of-pocket spend requirement).[1][5][6] - Meet **income requirements**: Household adjusted gross income (AGI) from your most recent federal tax return must be at or below a certain level, typically **200-300% of the Federal Poverty Level (FPL)** based on program guidelines. Exact thresholds aren't fixed percentages in all docs, but income is verified annually.[1][6][9][10] - Have a prescription from a licensed U.S. healthcare provider (HCP).[2][3] **Important**: Patients eligible for Medicaid must apply and be denied first. The program reserves the right to change rules or cancel anytime.[4][10] ## Income Eligibility Breakdown Income is based on your **annual household AGI** from the most recent federal tax return (e.g., Form 1040). Household size includes you and dependents. While exact FPL percentages vary (sources cite 200% or 300%), provide your AGI for verification. Electronic income checks may occur with consent.[3][9] Here's a sample table using **2026 Federal Poverty Guidelines** (approximate; check current FPL at aspe.hhs.gov for your state, as Alaska/Hawaii differ). Assume 250% FPL as a common threshold—call to confirm your case: | Household Size | 100% FPL (48 States) | ~200% FPL | ~300% FPL | |---------------|----------------------|------------|------------| | 1 | $15,060 | $30,120 | $45,180 |[6][10] | 2 | $20,440 | $40,880 | $61,320 | | 3 | $25,820 | $51,640 | $77,460 | | 4 | $31,200 | $62,400 | $93,600 | *Add ~$5,380 per extra person for 100% FPL.* Your AGI must be **at or below** the limit for your household. Attach tax return; other proofs like W-2, 1099, or unemployment statements may be requested.[4][9][10] ## Insurance Requirements - **Uninsured**: No prescription coverage? You're likely eligible if income qualifies.[6] - **Underinsured**: Limited coverage okay, but detail it on the application. List all insurance, including Medicare Part D (ID and enrollment year required if applicable). No $1,000 spend needed anymore.[1][3][5] - **Medicare**: Eligible without prior spend threshold. Provide denial if Medicaid-applicable.[1][10] - **Not eligible**: Full coverage or above-income patients.[6] ## Step-by-Step Application Process Applications start **by phone** at **(866) 668-6336**, though newer processes use online portals initiated by your doctor.[1][3][5] Here's how: 1. **Contact the program**: Call (866) 668-6336 (or 866-310-7549 M-F 8am-8pm ET). Anyone can start with patient permission; no pre-form needed.[3][6] 2. **Doctor's role**: Your HCP completes the prescriber section (product, dosage, signature, therapy type: initial or renewal). They may start online and eRx to Neovance Pharmacy (NPI 1780811125) or call 1-800-488-5908.[2][3][5] 3. **Your info**: Provide name, address (no P.O. boxes), DOB, SSN, household size, phone/email, insurance details. Consent to electronic income/insurance verification.[3][4] 4. **Submit documents**: Most recent federal tax return (required). May need: Government ID, Medicaid denial, Medicare details, W-2/1099.[1][2][4][10] 5. **Online option**: HCP starts portal; you get email link to finish. Fax/mail outdated—use online/phone.[3][5] 6. **Sign consents**: Allow program to verify info, contact you/HCP, audit if needed.[2][3] Mail/fax if specified: Novo Nordisk PAP, PO Box 370, Somerville, NJ 08876; Fax 866-441-4190.[3][4] ## Timeline and Delivery - **Processing**: 2 business days if complete; delays for missing info. Enrollment decision via mail, SMS, or phone if opted in.[1][3][5] - **Delivery**: Up to 10-14 business days (21 days max) after approval to your **HCP's office** (90-day supply). Pick up there.[2][3] - **Program duration**: Up to **12 months** rolling; income docs annual. Reapply for renewals/new products.[2][4] ## Alternatives if Denied or Ineligible - **Ask why**: Letter explains (e.g., income, insurance). Fix and reapply.[1][4] - **Other aid**: Check Partnership for Prescription Assistance (pparx.org), NeedyMeds, or RxAssist. Medicare Extra Help if low-income. Manufacturer copay cards via NovoCare.com (not for gov't insurance).[8] - **Biosimilars**: None listed for Activella.[Provided Data] - **Generic options**: Ask doctor about estradiol/norethindrone alternatives. ## Disclaimer This guide is for informational purposes based on available program details as of 2026. Rules change; **call (866) 668-6336** for latest. Not medical/financial advice. Eligibility not guaranteed. Novo Nordisk may audit/deny anytime. Consult your doctor.[1][2][4]

Program information last verified: March 30, 2026