Save on Vagifem®.

Everyone can use a helping hand when it comes to prescription costs, and Novo Nordisk would like to extend ours to you. If you’re eligible, we can help with your prescription costs for Vagifem® (estradiol vaginal tablets) 10 mcg. Use the Instant Savings Card to save up to $40 on each of your first 4 Vagifem® prescriptions. (This 1-year offer only applies for cards activated by December 31, 2013.)

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Eligibility.

We are not able to offer the Instant Savings Card to patients who are under 18 years of age, who are not residents of the United States, or who are covered by any of the following programs:

  • Medicaid
  • Medicare
  • Medigap
  • VA
  • DOD
  • TriCare
  • other state or federal employee benefits programs
  • other federal, state, or government-funded medical or prescription benefits programs

If you become covered by 1 of these programs in the future, you will no longer be eligible to receive the Instant Savings Card savings on Vagifem®. We may contact you by e-mail periodically to verify that your eligibility for the program has not changed. Please see the complete eligibility information in the disclaimer at the bottom of this form.

Patient Assistance Program.

The Novo Nordisk Patient Assistance Program provides treatment to eligible patients who can’t afford the medication. Please visit the Novo Nordisk Web site to learn whether you qualify.

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