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ForumsInsurance & AccessPharmaceutical patient assistance programs — May 2025

Pharmaceutical patient assistance programs — May 2025

SarahChen_PharmD Wed, Jul 2, 2025 at 10:41 AM 23 replies 1,693 viewsPage 1 of 5
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SarahChen_PharmD
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Dec 2023
San Diego, CA
Jul 2, 2025 at 12:06 PM#1

I'm trying to navigate the manufacturer patient assistance programs (PAPs) for GLP-1 medications and finding the process overwhelming. Can we compile what's actually available?

My situation: 62 years old, Medicare Part D, A1C of 7.1 (type 2 diabetic), BMI 39. My Part D plan covers Ozempic but my monthly copay is $312 until I hit the catastrophic threshold. I make about $38,000/year and after rent, utilities, and other medications, I simply cannot afford $312/month.

I've heard Novo Nordisk has an assistance program but the website is confusing and I can't tell if I qualify. Has anyone actually gotten free or reduced-cost medication through these programs?

4 24Dr.ObesityLA, NurseKim_ATL, paul_denver and 1 other
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alex_tucson
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May 2024
Tucson, AZ
Jul 2, 2025 at 12:23 PM#2

Maria, I help patients navigate PAPs professionally. Here's the current landscape:

Novo Nordisk PAP (for Ozempic, Wegovy, Rybelsus):

  • Income limit: generally ≤ 400% Federal Poverty Level ($62,400 for individual in 2026)
  • Must have Medicare or be uninsured — commercial insurance patients generally don't qualify
  • Must have been denied or have inadequate coverage
  • If approved: medication provided FREE for 12 months (renewable)
  • Application: NovoCare.com or call 1-866-310-7549

Lilly Cares PAP (for Mounjaro, Zepbound):

  • Income limit: ≤ 400% FPL
  • Similar requirements — Medicare or uninsured
  • If approved: medication provided FREE
  • Application: LillyPricingInfo.com or 1-800-545-6962

At $38,000/year, you're well under the 400% FPL threshold. You should absolutely qualify. The application requires proof of income (tax return or pay stubs) and a prescription from your doctor.

Last edited: Jul 2, 2025 at 2:23 PM
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LipidDoc_ATL
Senior Member
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Apr 2024
Atlanta, GA
Jul 2, 2025 at 12:40 PM#3

I got approved for the Novo PAP for Ozempic in October 2025. Here's what the process actually looked like:

  1. Downloaded application from NovoCare.com (4 pages)
  2. My doctor filled out the prescription section
  3. I provided proof of income (2024 tax return)
  4. Mailed the application (can also fax)
  5. Got a call 12 days later saying I was approved
  6. Medication shipped directly to my home via FedEx, cold-packed
  7. 90-day supply at a time, auto-ships quarterly

Total cost to me: $0. Not even shipping. I've received 3 shipments so far without any issues.

The one downside: it took about 3 weeks from application to first shipment. If you're currently on the medication, make sure you have enough to bridge the gap. If you're starting fresh, plan for the wait time.

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NurseKim_ATL
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Feb 2024
Atlanta, GA
Jul 2, 2025 at 12:57 PM#4

Diane, Jim — thank you SO much. I had no idea the income limit was that high. I was assuming it was for people near the poverty line only.

I'm going to download the application tonight. Quick question: my doctor currently prescribes Ozempic 1mg. Do they need to write a new prescription for the PAP, or can they use my existing one?

Also — if I get free Ozempic through the PAP, does it affect my Part D coverage for other medications? I also take metformin and lisinopril through Part D.

38 13pete_nash, hank_denver, carlos_SATX and 35 others
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mark_tokyo
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Jun 2024
Tokyo, JP
Jul 2, 2025 at 1:14 PM#5

Your doctor will need to complete the prescription section on the PAP application form — it's essentially a new prescription specifically for the program. Your existing pharmacy prescription can continue as a backup.

Regarding your Part D: No, receiving medication through a PAP does NOT affect your Part D coverage for other drugs. The PAP operates completely outside of your insurance. Your metformin and lisinopril will continue through Part D as normal.

One thing to note: medication received through a PAP does NOT count toward your Part D out-of-pocket spending. So if you're getting Ozempic free through the PAP, those costs won't help you reach the catastrophic coverage threshold faster. For some patients this matters; for you, it probably doesn't since you're trying to reduce spending, not hit OOP max faster.

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