Novo Nordisk and Lilly Patient Assistance Programs Explained

There are four different things people call “manufacturer help,” and mixing them up is the most common reason someone ends up surprised at the pharmacy counter.

1. A copay savings card — for people with commercial insurance. Reduces what you pay at the counter, up to a cap.
2. A self-pay price — for people paying cash, usually through the manufacturer’s own pharmacy channel.
3. A patient assistance program (PAP) — free medicine for people who meet income limits and have no commercial insurance.
4. A discount card like GoodRx — a third-party coupon, unrelated to the manufacturer.

They have opposite eligibility rules. A copay card generally requires commercial insurance; a patient assistance program generally requires that you not have it. This article covers the assistance programs and the fine print on the cards. Pricing tiers themselves are covered in our cost guides. None of this is medical advice. Where it describes how a medicine is used, it is summarizing FDA-approved labeling and Instructions for Use; follow your own prescription and your prescriber’s directions.

Who qualifies for the Novo Nordisk Patient Assistance Program?

The Novo Nordisk PAP provides medicine at no cost to people who qualify, with no registration charge or monthly fee. For 2026 the published eligibility rules are [1][2]:

• You must be a US citizen or legal resident.
• You must have Medicare or no insurance. If you have private or commercial insurance, you are not eligible.
• You must not be enrolled in or qualify for any other federal, state or government program such as Medicaid, the Medicare Low-Income Subsidy (Extra Help) or VA benefits. If you are eligible for Medicaid or LIS, you must submit a copy of your denial letter with the application.
• Household income must be at or below 400 percent of the federal poverty level for most Novo medicines — but 200 percent for Ozempic, which for 2026 is available through the program only to uninsured applicants.
• Uninsured applicants whose income falls within their state’s Medicaid thresholds must provide proof of a Medicaid denial before enrollment. Novo publishes the 150 percent federal poverty level Extra Help denial requirement under the heading for Medicare patients on Novo Nordisk insulins rather than as a program-wide rule, so if you are a Medicare applicant on another product, ask NovoCare whether it applies to you.

Two changes for 2026 matter a lot. First, Medicare beneficiaries with prescription drug coverage are no longer eligible to receive Ozempic through the PAP; Novo points those patients to the Medicare Prescription Payment Plan instead [1][3]. Second, Novo removed the old requirement that Medicare Part D patients spend $1,000 out of pocket before applying — its FAQ now answers that question “No, we no longer require that Medicare Part D patients spend $1000 out of pocket to be eligible for the program” (verified 2026-09-14) [1].

Novo also states that some medicines left the Patient Assistance Program for 2026 and directs applicants to the current covered-product list [1].

Wegovy is not among the products listed on NovoCare’s published Patient Assistance Program page as retrieved on September 14, 2026 — the page’s covered-medicine content is built around Novo’s diabetes portfolio and its insulins [1][2]. That is an absence from a list rather than a statement of exclusion by Novo, and the list is revised without notice, so confirm before you build a plan around it: check the live covered-product list or call 1-866-310-7549. If Wegovy is not covered, the realistic routes for an uninsured patient are Novo’s own self-pay pricing and, for eligible Medicare beneficiaries, the Medicare GLP-1 Bridge.

How the Novo application works

Enrollment moved online only [1]:

1. Patient portion. You complete your section through the application portal and supply an accurate email address for your provider’s office, which completes its portion.
2. Supporting documents. Medicare patients below 150 percent of the federal poverty level submit a Low-Income Subsidy denial letter. Uninsured patients submit a state Medicaid denial letter. Residents of Maine or Minnesota submit a government photo ID. Anyone who did not file taxes, or had a life event affecting income, submits proof of income such as three recent pay stubs, a W-2 or a 1099.
3. Approval and delivery. A complete application with all documentation is processed within 2 business days. If approved, Novo contacts your doctor for a prescription and Neovance Specialty Pharmacy calls at 1-800-488-5908 to schedule home delivery, typically within 5 business days. Shipping is covered. Medicine ships to your home, not your doctor’s office, and cannot be shipped to a local pharmacy.
4. Term and renewal. Uninsured patients are enrolled for 12 months; Medicare patients through the end of the current calendar year. You must reapply when enrollment ends, and you may submit a new application 30 days before it does. Medicare Part D patients may apply after October 15 for the following year.

Who qualifies for Lilly Cares?

The Lilly Cares Foundation provides prescribed Lilly medicines free of charge for up to 12 months to qualifying US patients. Unlike Novo’s single threshold, Lilly Cares sets income limits by medication group, using federal poverty level guidelines. These are income ceilings, not prices — approved patients pay nothing. The 2026 application lists the following (verified 2026-09-14 against the program’s own application, form CMAT-02998 12/2025, which states the limits reflect 2026 federal poverty guidelines) [5]:

Household size	1	2	3	4
Group 1 (≤300% FPL)	$47,880	$64,920	$81,960	$99,000
Group 2 (≤400% FPL)	$63,840	$86,560	$109,280	$132,000
Groups 3 & 4 (≤500% FPL)	$79,800	$108,200	$136,600	$165,000

Alaska and Hawaii residents, and households larger than four, call 1-800-545-6962 for adjusted limits [5]. Group 4 medications are for patients with household adjusted gross income at or below 500 percent FPL who have no insurance, have Medicare Part D, or have Medicare Part B without supplemental or secondary insurance; if your insurance does not cover a Group 4 medication, you may still qualify [4].

The Zepbound question

Zepbound is not on the Lilly Cares medication list — and neither is Mounjaro. The Available Medications table printed in the program’s own application, captured on September 14, 2026, lists Cialis, Emgality, Forteo, Reyvow and Trulicity in Group 1; Basaglar, Humalog, Humulin and Lyumjev in Group 2; Ebglyss, Omvoh (infusion and injection), Olumiant and Taltz in Group 3; and Cyramza, Erbitux, Inluriyo, Jaypirca, Kisunla, Retevmo and Verzenio in Group 4 [5]. Trulicity is the only GLP-1 anywhere on it. Lilly has not publicly explained the omission of the tirzepatide products.

This corrects an earlier version of this page, which reported — on secondary checks of the web version of the list — that Mounjaro was included while Zepbound was not. The program application is the primary document and it excludes both.

Two honesty notes. First, the lillycares.com web pages still block automated retrieval (HTTP 403), so the application PDF rather than the website is the capture behind this. Second, an absence from a published list is not a formal statement of exclusion, the program says it will review off-list requests if you supply a prescription and a documented coverage denial, and program lists change. Confirm before you rely on it: check the current medication list at lillycares.com or call Lilly Cares at 1-800-545-6962. If Zepbound is not covered, the practical alternatives for an uninsured Zepbound patient are the manufacturer’s own self-pay channel and, for eligible Medicare beneficiaries, the Medicare GLP-1 Bridge.

The rule that disqualifies people through no fault of their own

Lilly Cares states explicitly that the program is charitable assistance for patients in financial need, and that “if an employer, plan, or other third-party directs patients to apply to the Lilly Cares Program as a condition of, requirement for, or prerequisite to coverage, or in any way adjusts coverage based on application to or availability of the Lilly Cares Program, those individuals are not eligible” [4].

That is aimed at alternative funding programs, and it matters to you if your benefits vendor told you to apply. More on that below.

What do the savings cards actually cover?

Wegovy Savings Offer. People with commercial (non-government) drug insurance that covers Wegovy may pay as little as $25, subject to a maximum savings of $100 per 1-month prescription, $200 per 2-month prescription, or $300 per 3-month prescription (verified 2026-09-14 against Novo Nordisk’s own terms and conditions, which state: “Pay as little as (‘PALA’) $25, subject to a maximum savings of $100 per 1-month prescription (‘Savings Benefit’), $200 per 2-month prescription, or $300 per 3-month prescription”) [9]. Novo prints that sentence twice — once for the Wegovy injection at 0.25, 0.5, 1, 1.7, 2.4 and HD 7.2 mg, and once for Wegovy tablets at 1.5, 4, 9 and 25 mg — so the same ceilings apply to pen and pill alike. These are copay-card ceilings, not prices: the card reduces whatever your plan leaves you owing by at most the stated amount. A “1-month” fill is one box of 4 single-dose prefilled pens (a 28-day supply) or one bottle of 30 tablets (a 30-day supply), with 2- and 3-month fills the corresponding multiples. Government beneficiaries are excluded, though Novo says government-insured patients may use the program if they self-pay and process outside their insurance — and Novo states that Federal Employees Health Benefits, health exchange plans and state employee plans are not treated as government health care programs for this offer [8][9]. Availability in Massachusetts depends on the state law in effect when you present the offer. Novo reserves the right to rescind, revoke or amend the offer without notice at any time [9].

An earlier version of this page reported the $200 and $300 tiers as unconfirmed, because they do not appear on NovoCare’s consumer savings-offer page. They are published — in Novo’s own savings-offer terms and conditions, on the same novocare.com domain. Both figures are now verified at source.

Wegovy self-pay prices (a separate channel, not the card). If you have no insurance, or insurance that does not cover Wegovy, or you choose to process outside your plan, Novo publishes fixed cash prices in the same terms document (verified 2026-09-14) [9]. For tablets the standard prices are $149 per month for 1.5 mg ($298 for two months, $447 for three), $199 for 4 mg ($398 / $597), and $299 for 9 mg and for 25 mg ($598 / $897). For pens the standard price is $349 per month for 0.25 through 2.4 mg ($698 / $1,047), and $399 per month for Wegovy HD 7.2 mg ($798 / $1,197). Two limited-time introductory offers sit on top: patients new to the Wegovy Savings Offer or to NovoCare Pharmacy pay $199 for each of their first two 28-day fills of 0.25 mg or 0.5 mg pens, redeemable through December 31, 2026, with the third fill reverting to $349; a matching $149 introductory price for 4 mg tablets expired August 31, 2026, so 4 mg now prices at the standard $199. Novo labels the pen pricing a limited-time offer to be updated after December 31, 2026. Self-pay spending does not count toward a deductible or out-of-pocket maximum, and Novo’s terms require you not to submit it for reimbursement.

Zepbound Savings Card. Lilly runs more than one offer, and they attach to different device forms. All expire December 31, 2026 [10][11][20]:

• Covered-benefit card — for people whose commercial plan covers the Zepbound single-dose pen. Pay as little as $25 per 1-, 2- or 3-month fill, with maximum savings of $100, $200 or $300 per fill respectively and a separate annual maximum of $1,300 per calendar year, for up to 13 fills. A “month” is 28 days and up to 4 single-dose pens.
• Non-covered-benefit card, single-dose pen — for people with commercial insurance whose plan does not cover the Zepbound single-dose pen. The pen is priced as low as $499 for a 1-month fill, with maximum monthly savings equal to wholesale acquisition cost minus $499, up to 13 fills a year.
• Non-covered-benefit card, KwikPen — for people whose commercial insurance does not cover the single-patient-use KwikPen. This one is a dose ladder, not a single number: $299 for 2.5 mg (maximum monthly savings up to $215), $399 for 5 mg (up to $115), $449 for 7.5 mg (up to $65), and $449 for 10 mg, 12.5 mg and 15 mg (up to $271). For every KwikPen dose a “month” is 28 days and up to one KwikPen, and the card allows only 11 fills per calendar year, not 13 [10][20].
• The $449 purchase offer — the separate terms that govern the KwikPen prices above at 7.5 mg and higher. The $449 price is applied automatically on your first purchase of the 7.5, 10, 12.5 or 15 mg KwikPen, and you keep it only if you buy each refill within 45 days of the delivery date of the previous fill. Lilly’s published regular price for a 1-month KwikPen supply is $299 for 2.5 mg, $399 for 5 mg, $499 for 7.5 mg and $699 for 10 mg, 12.5 mg and 15 mg [10][20].

An earlier version of this page described the $449 offer as covering “the 7.5 mg, 10 mg, 12.5 mg and 15 mg Zepbound single-dose vial or single-patient-use KwikPen” with a flat $271 maximum monthly saving. Lilly’s live terms name the KwikPen only, add the 2.5 mg and 5 mg rungs, and set a different maximum saving at each dose, so the $271 figure applies to 10, 12.5 and 15 mg — not to 7.5 mg, where it is $65. All figures in this section were read verbatim from Lilly’s terms on September 14, 2026.

The device distinction is the trap. If you assume the 13-fill covered-benefit terms apply to a KwikPen, you will be two fills short by December.

Lilly may terminate, rescind, revoke or amend these offers at its sole discretion, without notice, for any reason [10].

Why the caps matter more than the headline

The “$25 a month” number gets the headline; the cap decides your year.

If your plan leaves you owing $600 a month, a $100 monthly maximum brings you to $500, not $25. And on the Zepbound covered-benefit card, $100 of savings a month exhausts the $1,300 annual maximum after 13 fills. People who start in January often find their cost jumps sharply late in the year — the “copay cliff.”

What are copay accumulators and maximizers?

This is the mechanism that quietly removes the rest of the savings card’s value.

A copay accumulator lets your plan accept the savings card at the pharmacy but excludes that money from your deductible and out-of-pocket maximum. You feel fine until the card’s annual limit runs out, at which point you discover you have made far less progress toward your deductible than you thought.

A copay maximizer works differently and is arguably gentler. Instead of ignoring the card, the plan raises your monthly cost share to a calculated amount designed to drain the card evenly across all twelve months. There is no mid-year cliff, but the plan still never pays and the money still does not count toward your accumulators [12].

All three major pharmacy benefit managers offer these products to employer clients. Drug Channels estimated that for 2025 about 17 percent of the US commercial market — more than 34 million people — were in plans required by state law to count copay assistance toward cost-sharing limits, and reported that New Jersey became the 26th state with such a law in January 2026 [12]. Those state laws apply to fully insured plans. They do not reach self-funded employer plans, which is where most large-employer coverage sits.

Manufacturers push back in their own terms. Savings programs across the industry commonly reserve the right to reduce or discontinue assistance for patients the manufacturer determines are subject to an accumulator or maximizer.

The question to ask your plan: “Does manufacturer copay assistance count toward my deductible and out-of-pocket maximum?” Get the answer before you rely on a card.

What is an alternative funding program, and how do I know if I am in one?

Alternative funding programs (AFPs) are third-party vendors sold to self-funded employers as a way to move specialty drug costs off the plan. The mechanics are roughly [13][14]:

1. The plan excludes the drug, or reclassifies it as a non-essential health benefit.
2. A vendor contacts the patient and offers to obtain the drug through a manufacturer patient assistance program, a charitable foundation, or sometimes an international pharmacy.
3. If those routes fail and the employer does not override the exclusion, the patient can be left responsible for the full cost — and those costs do not count toward the deductible or out-of-pocket maximum [14].

Warning signs you may be in one: a third-party company you have never heard of contacts you about your medication; you are told you must apply for charity or manufacturer assistance before the plan will pay; or you are told that if you decline to work with the program you will be responsible for 100 percent of the drug’s cost [15].

The cruelty of the design is that it can backfire on the patient, and both manufacturers have written the trap into their own terms. Patient advocacy organizations report cases of people rejected by manufacturer assistance programs because the application appeared to come through an AFP [15]. Lilly Cares disqualifies applicants directed by an employer, plan or third party as a condition of coverage [4]. And Novo’s Wegovy savings offer terms, last updated July 28, 2026, state that if your insurance plan participates in an alternative funding program that requires you to apply for the Wegovy Self Pay Offer or to seek coverage through an alternate funding vendor as a condition of covering Wegovy, “you are not eligible to use the Wegovy Savings Offer” — and that you agree to notify the program if you become enrolled in such an arrangement [9].

If this is happening to you, ask the vendor and your employer, in writing, what happens if the charity denies you, and whether the plan will override the exclusion. Aimed Alliance and the PAN Foundation both publish patient-rights guidance on this.

How does GoodRx fit in?

It does not stack. A GoodRx coupon and an insurance claim cannot both be applied to the same fill — the pharmacy runs one or the other [17]. Choosing the coupon means the spending does not count toward your deductible. Manufacturer copay cards are the mirror image: they generally require commercial insurance, are billed secondary to it, and exclude anyone with Medicare, Medicaid or TRICARE [16].

In practice, discount cards are useful when you are uninsured, when the drug is not covered, when a claim is denied, or when the coupon price beats your copay. For GLP-1s specifically, the manufacturers’ own self-pay channels have generally undercut discount-card pricing.

A decision path

• Commercial insurance that covers the drug → savings card, and ask whether the assistance counts toward your deductible.
• Commercial insurance that does not cover the drug → non-covered-benefit savings card where one exists, or the manufacturer’s self-pay channel, or a formulary exception if your plan offers one.
• No insurance, low income → patient assistance program. Confirm the product is on the current list and that you can produce the required denial letters.
• Medicare → savings cards are off the table. Look at the Medicare GLP-1 Bridge if you are using the drug for weight management, at Part D coverage if another approved indication applies, and at the Medicare Prescription Payment Plan to spread Part D out-of-pocket costs across the year [18].
• Medicaid or TRICARE → savings cards are off the table. Work with the plan’s own coverage rules and appeal process.

And keep the paperwork. Enrollment terms, renewal dates and annual caps are the three things that catch people out, and all three are written down.

Sources

1. Novo Nordisk / NovoCare, Novo Nordisk Patient Assistance Program (PAP). https://www.novocare.com/diabetes/help-with-costs/pap.html
2. Novo Nordisk / NovoCare, Novo Nordisk PAP Information for HCPs. https://www.novocare.com/hcp/diabetes/help-with-costs/pap.html
3. 340B Price Guide, Novo Nordisk Changes Patient Assistance Program (PAP) 2026. https://www.340bpriceguide.net/articles-news/143-changes-to-novo-nordisk-patient-assistance-program-pap-2026
4. Lilly Cares Foundation, How to Apply. https://www.lillycares.com/how-to-apply
5. Lilly Cares Foundation, Patient Assistance Program Application (PDF). https://www.lillycares.com/assets/pdf/lilly_cares_application.pdf
6. CoveredUSA, LillyDirect Self-Pay Pricing 2026: Zepbound and Mounjaro. https://coveredusa.org/en/drug/lilly-direct-self-pay-pricing
7. Honest Care, Zepbound Copay Assistance & Financial Help 2026. https://www.findhonestcare.com/treatments/zepbound/cost/patient-assistance
8. Novo Nordisk / NovoCare, Savings Offer Program for Wegovy (semaglutide). https://www.novocare.com/patient/medicines/wegovy/savings-offer.html
9. Novo Nordisk / NovoCare, Wegovy Savings Offer — Terms and Conditions of Use (Standard Savings Offer and Self-Pay Offer), read verbatim September 14, 2026. https://www.novocare.com/eligibility/wegovy-savings-card.html
10. Eli Lilly and Company, Savings & Insurance Options | Zepbound. https://zepbound.lilly.com/savings
11. Drugs.com, What is the Zepbound Coupon or Savings Card? https://www.drugs.com/medical-answers/what-zepbound-coupon-savings-card-3578017
12. Drug Channels Institute, Copay Accumulators and Maximizers in 2025, February 10, 2026. https://www.drugchannels.net/2026/02/copay-accumulators-and-maximizers-in.html
13. PAN Foundation, How alternative funding programs prevent access to medications. https://www.panfoundation.org/how-alternative-funding-programs-prevent-access-to-medications
14. Pharmaceutical Commerce, FAQ: Decoding Alternative Funding Programs. https://www.pharmaceuticalcommerce.com/view/faq-decoding-alternative-funding-programs
15. Fierce Healthcare, Middlemen offer ‘alternative funding’ for specialty drugs at risk to patients. https://www.fiercehealthcare.com/payers/new-wave-middlemen-promise-savings-specialty-drugs-patients-bear-risks
16. GoodRx, Manufacturer Copay Cards: Everything You Need to Know. https://www.goodrx.com/drugs/savings/what-are-manufacturer-copay-cards
17. GoodRx, GoodRx Coupons for Brand Drugs: A Detailed Overview. https://www.goodrx.com/drugs/savings/goodrx-coupon
18. Centers for Medicare & Medicaid Services, Medicare Prescription Payment Plan. https://www.cms.gov/medicare/health-drug-plans/medicare-prescription-payment-plan
19. NiceRx, Zepbound patient assistance program: the complete guide. https://www.nicerx.com/blog/zepbound-patient-assistance-program
20. Eli Lilly and Company, Zepbound Savings Card and Purchase Offer Terms and Conditions, read verbatim September 14, 2026. https://zepbound.lilly.com/savings#terms-and-conditions-2