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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, who are not enrolled in a commercial insurance plan, or who are covered by any of the following programs:
- other state or federal employee benefits programs
- other federal, state, or government-funded medical or prescription benefits programs
If you become covered by one 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 email 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 medication to eligible patients who can’t afford their medication. Please visit the Novo Nordisk website to learn whether you qualify.More