TRESIBA® INSTANT SAVINGS CARD
Details of Offer Including Restrictions on Eligibility and Other Limitations
You are not eligible for this savings offer if you are enrolled in or participate in Medicaid, Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program (each a Government Program), or where prohibited by state law. The Federal Employees Health Benefits (FEHB) Program is not a Government Program for the purposes of this savings program. You must not submit, or have submitted on your behalf by a pharmacist or other third party, a claim for reimbursement or coverage to any Government Program for items purchased with this savings card.
Program terms and conditions:
- Pay as little as $15 out of pocket. Novo Nordisk will pay up to $500 of your co-pay for each of your first 24 prescription fills for 2 years from the time of initial card activation. Eligibility and other restrictions apply. Novo Nordisk reserves the right to modify or cancel this program at any time. If your co-pay is already $15 or less, this offer does not apply.
- Get 1 free box of Novo Nordisk needles when you activate your Savings Card and enroll in the program. Maximum savings of $500. Limit 1 box of needles per person. Needles are sold separately and may require a prescription in some states. Needles must not be shared.
- Offer good only in the USA, Puerto Rico, Guam, Saipan and Virgin Islands at participating retail pharmacies and cannot be redeemed at government-subsidized clinics. Void where taxed, restricted, or prohibited by law.
- Absent a change in Massachusetts law, effective July 1, 2017, the Savings Card will no longer be valid for residents of Massachusetts.
- Patients must be enrolled in a commercial insurance plan. Offer excludes full cash-paying patients.
- Patient is responsible for complying with any insurance carrier co-payment disclosure requirements, including disclosing any savings received from this program.
- Re-confirmation of information may be requested periodically to ensure accuracy of data and compliance with terms.
- Patient must be 18 years of age or older to redeem the Savings Card.
- Participating patients must re-present their Tresiba® Instant Savings Card if changing pharmacies.
- This offer is limited to 1 card per patient. This card is not transferable.
- The Tresiba® Instant Savings Card may be used for mail order.
- Participating pharmacists must comply with all applicable laws and contractual or other obligations as a pharmacy provider.
- Participating patients and pharmacists understand and agree to comply with the terms and conditions of this offer as set forth herein.
- This savings program cannot be combined with any other coupon, certificate, voucher, or similar offer.
- This is not an insurance program.