Xultophy

Indicated For

Type 2 diabetes

About This Medication

# Novo Nordisk Patient Assistance Program Guide: How to Get Xultophy at Low or No Cost ## About This Program The Novo Nordisk Patient Assistance Program (PAP) is a free program designed to help uninsured and underinsured patients access Xultophy (insulin degludec and liraglutide) at little to no cost. Xultophy is a combination medication that helps people with type 2 diabetes manage their blood sugar levels more effectively. If you're struggling to afford this medication, this program may be able to help. ## What is Xultophy? Xultophy is a prescription injectable medication that combines two active ingredients: - **Insulin degludec**: A long-acting basal insulin that helps control blood sugar throughout the day - **Liraglutide**: A GLP-1 receptor agonist that helps your body use insulin better and may reduce appetite This combination medication is specifically approved to treat type 2 diabetes in adults. It comes in a pre-filled pen that you inject once daily. ## Who Can Apply? You may be eligible for the Novo Nordisk Patient Assistance Program if you: - Have type 2 diabetes and a valid prescription for Xultophy from your doctor - Are a U.S. resident (including Puerto Rico) - Are uninsured or underinsured (meaning your insurance doesn't cover Xultophy or you can't afford the cost) - Meet the income requirements based on your household size (see income table below) - Do not have Medicare coverage (Note: As of 2026, Medicare beneficiaries are no longer eligible) ## Income Eligibility Guidelines Your eligibility is based on your total household income. The program uses federal poverty guidelines as a reference, though exact income thresholds may vary. Here's a general guideline: | Household Size | Approximate Maximum Annual Income | |---|---| | 1 person | Varies (check with program) | | 2 people | Varies (check with program) | | 3 people | Varies (check with program) | | 4 people | Varies (check with program) | | 5 people | Varies (check with program) | | 6+ people | Varies (check with program) | **Note**: Income limits fluctuate annually. Contact the program directly at **(866) 310-7549** to confirm your specific eligibility based on your household income. ## Insurance Requirements - **Uninsured patients**: You qualify if you have no health insurance - **Underinsured patients**: You may qualify if your insurance doesn't cover Xultophy or if your out-of-pocket costs are too high - **Medicare patients**: Unfortunately, as of 2026, Medicare beneficiaries are no longer eligible for this PAP. If you have Medicare, ask your doctor about other programs or speak with your Medicare plan about coverage options - **Medicaid patients**: Generally, if you have Medicaid, you should work with your state program first ## How to Apply ### Step 1: Gather Required Documents Before you start, collect these documents: - **Proof of income**: Recent tax return, W-2, pay stub, or benefit statement - **Proof of residency**: Utility bill, lease, or government ID with your current address - **Prescriber information**: Your doctor's name, phone number, and NPI (National Provider Identifier) - Your valid prescription for Xultophy ### Step 2: Choose Your Application Method You can apply online at **https://www.novocare.com/diabetes/help-with-costs/pap.html** If you prefer, you can also: - Call the program at **(866) 310-7549** to apply by phone or request a paper application - Fax a completed application to **(866) 441-4190** ### Step 3: Complete the Application - Follow the online form or fill out the paper application completely - Include all required documents (copies are fine) - Double-check that all information is accurate and legible - Make sure your doctor's information is correct so they can verify your prescription ### Step 4: Submit Your Application - **Online**: Submit directly through the website - **By mail**: Send to the address provided with your application form - **By fax**: Use the fax number above ### Step 5: Wait for Approval The program typically processes applications within **4-8 weeks**. You'll receive notification about your approval status by mail or email. ## After Approval ### Receiving Your Medication Once approved, Xultophy will be shipped directly to you at no cost. The program will coordinate with your pharmacy and doctor to ensure you receive your medication. ### How Much Will I Pay? If approved, you may receive Xultophy at no cost, or at a very low copay, depending on your specific situation. ### How Long Does the Assistance Last? Assistance is provided for one year. You'll need to reauthorize annually to continue receiving medication through the program. ## Additional Savings Options Even if you don't qualify for the PAP or while you're waiting for approval, ask about: - **Novo Nordisk Savings Card**: Check the Novo Nordisk website for current savings cards that may reduce your copay at the pharmacy - **State pharmaceutical assistance programs**: Your state may offer additional programs for medications - **Other manufacturer programs**: Ask your doctor or pharmacist about other resources ## If Your Application is Denied If you don't qualify, don't lose hope. You have options: - Ask why you were denied—you may be able to provide additional information - Contact the program to discuss your specific situation - Ask your doctor about sample medications or alternative options - Look into state-run pharmaceutical assistance programs - Visit **NeedyMeds.org** for additional resources and programs - Call your local health department or community health center for referrals ## Contact Information **Novo Nordisk Patient Assistance Program** - **Phone**: (866) 310-7549 - **Fax**: (866) 441-4190 - **Online**: https://www.novocare.com/diabetes/help-with-costs/pap.html - **Hours**: Available Monday-Friday (specific hours available when you call) ## Important Reminders - Keep taking your current diabetes medication until you receive approval and your new Xultophy supply - Be honest and complete in your application—false information could disqualify you - Annual reauthorization is required to continue the program - If your income or insurance changes, contact the program to update your information - Never stop taking your diabetes medication without talking to your doctor ## Legal Disclaimer This guide is for informational purposes only and does not constitute medical advice. Program eligibility, benefits, and requirements are subject to change. For the most current and accurate information about the Novo Nordisk Patient Assistance Program, visit https://www.novocare.com/diabetes/help-with-costs/pap.html or call (866) 310-7549. Always consult with your healthcare provider about your diabetes treatment options.

Program information last verified: March 25, 2026