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Published: Friday, 10 October 2025 09:13

Written by 340B Editor

Novo Nordisk recently announced changes to the eligibility criteria for its Patient Assistance Program for 2026. 

2026 Patient Assistance Program (PAP) Eligibility Changes | NovoCare®

Sara Jones, Consulting Pharmacist at Northwest Human Services in Salem, Oregon, identified and summarized Novo Nordisk’s changes:

Summary of changes:

1. Medicare patients are no longer eligible to receive Ozempic:  Novo Nordisk indicates this is because “98% of patients have Medicare beneficiaries have access to Ozempic.” Patients will continue to receive Ozempic through the end of 2025.

2. Uninsured Patients: 
a. Uninsured Patients' income must be less than 200% FPL.
b. They MUST include a copy of a denial letter from Medicaid.

3. Unbranded insulin products will no longer be available.  The program will continue to carry Tresiba and Novolog.

Patients on PAP are being notified of changes directly from Novo Nordisk. However, you may receive requests for a new prescription for Ozempic to be issued to the patient's preferred pharmacy.

If a request is received to switch patients to a different insulin that Novo Nordisk still covers, Sara Jones, recommends that patients be notified when this occurs.

340B Pricing Option:
For patients who can pay out of pocket without insurance, below are the estimated 340B prices for select meds and generic alternatives:

 *As of 10/10/2025

From Novo Nordisk website:

2026 Eligibility Criteria and Additional Information

"The Patient Assistance Program (PAP) will continue to support patients with the greatest need. Medicare beneficiaries can still access Ozempic^® (semaglutide) injection 0.5 mg, 1 mg, or 2 mg for Type 2 Diabetes through most plans. Novo Nordisk is committed to advancing solutions to support access and affordability for all patients within the U.S. health care system."

What is changing in 2026 for the Novo Nordisk Patient Assistance Program (PAP)?
 For patients on Ozempic®
 Most Medicare Part D plans cover Ozempic®. Medicare beneficiaries with Part D coverage will no longer be eligible to receive Ozempic® through the Patient Assistance Program.
Next Steps:
Confirm your coverage: Evaluate your plan options before 2026 Open Enrollment, which begins on October 15, 2025 and ends on December 7, 2025.
Find available health plans: Information about available health plans can be found here starting October 1, 2025, as well as other information about enrollment and Medicare Part D.
Plan your spending: You also have the option of spreading your prescription costs throughout the plan year by enrolling in the Medicare Prescription Payment Plan (M3P). To learn more about this program, click here.
Uninsured patients will still have access to Ozempic® through the Patient Assistance Program; however, their total household income must be at or below 200% of the federal poverty level.
Next Steps:
Visit NeedyMeds website which lists the current FPL guidelines for more information.
  For Medicare patients on Novo Nordisk insulins
 
Medicare beneficiaries with a total household income below 150% of the federal poverty level must provide proof of denial for Part D Extra Help (Low Income Subsidy) to qualify.
Next Steps:
For more information on how to apply for the Extra Help Program, please click here. If you will be a Medicare patient in 2026 and meet eligibility requirements, please download the application in English or Spanish to apply.
Novo Nordisk has other programs to help make insulin affordable. Explore your options.
 
 For uninsured patients on all products
 
Uninsured patients must provide proof of a Medicaid denial prior to enrollment in the PAP if the patient’s total household income meets their state federal poverty limit thresholds. For more information about your state’s Medicaid program, you can click here. You can also visit the NeedyMeds website which lists the current FPL guidelines for more information.
Next Steps:
For uninsured insulin patients, Novo Nordisk has other programs to help make insulin more affordable. Click here for insulin affordability options.
 The following products will be removed from the Patient Assistance Program in 2026 for all patients:
 
RYBELSUS® (semaglutide) tablets 7 mg or 14 mg
All unbranded biologic insulins
 If you meet these eligibility requirements, you can apply for the Patient Assistance Program by downloading the application in English or Spanish. 
 

Important Safety Information for Ozempic®
Do not share your Ozempic® pen with other people, even if the needle has been changed. You may give other people a serious infection or get a serious infection from them.

What is the most important information I should know about Ozempic®?
Ozempic® may cause serious side effects, including:

Possible thyroid tumors, including cancer. Tell your health care provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Ozempic® and medicines that work like Ozempic® caused thyroid tumors, including thyroid cancer. It is not known if Ozempic® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.
Do not use Ozempic® if you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
What is Ozempic®?
Ozempic® (semaglutide) injection 0.5 mg, 1 mg, or 2 mg is an injectable prescription medicine used:

along with diet and exercise to improve blood sugar (glucose) in adults with type 2 diabetes.
to reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes with known heart disease.
to reduce the risk of kidney disease worsening, kidney failure (end-stage kidney disease), and death due to cardiovascular disease in adults with type 2 diabetes and chronic kidney disease.
It is not known if Ozempic® is safe and effective for use in children.

Important Safety Information
Do not use Ozempic® if:
you or any of your family have ever had MTC or if you have MEN 2.
you are allergic to semaglutide or any of the ingredients in Ozempic®. See symptoms of serious allergic reaction in “What are the possible side effects of Ozempic®?”.
Before using Ozempic®, tell your health care provider if you have any other medical conditions, including if you:
have or have had problems with your pancreas.
have a history of diabetic retinopathy.
have severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis) or problems with digesting food.
are scheduled to have surgery or other procedures that use anesthesia or deep sleepiness (deep sedation).
are pregnant or breastfeeding or plan to become pregnant or breastfeed. It is not known if Ozempic® will harm your unborn baby or pass into your breast milk. You should stop using Ozempic® at least 2 months before you plan to become pregnant.
Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements, and other medicines to treat diabetes, including insulin or sulfonylureas.

What are the possible side effects of Ozempic®?
Ozempic® may cause serious side effects, including:

inflammation of your pancreas (pancreatitis). Stop using Ozempic® and call your health care provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.
changes in vision. Tell your health care provider if you have changes in vision during treatment with Ozempic®.
low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use Ozempic® with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include: dizziness or lightheadedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, and feeling jittery.
dehydration leading to kidney problems. Diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems. It is important for you to drink fluids to help reduce your chance of dehydration. Tell your health care provider right away if you have nausea, vomiting, or diarrhea that does not go away.
severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use Ozempic®. Tell your health care provider if you have stomach problems that are severe or will not go away.
serious allergic reactions. Stop using Ozempic® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.
gallbladder problems. Gallbladder problems have happened in some people who take Ozempic®. Tell your healthcare provider right away if you get symptoms which may include: pain in your upper stomach (abdomen), fever, yellowing of the skin or eyes (jaundice), or clay-colored stools.
food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sleepiness (deep sedation). Ozempic® may increase the chance of food getting into your lungs during surgery or other procedures. Tell all your healthcare providers that you are taking Ozempic® before you are scheduled to have surgery or other procedures.
The most common side effects of Ozempic® may include nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation.

Please see Prescribing Information and Medication Guide for Ozempic®.

Ozempic® is a prescription medication.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.

 
 
Important Safety Information for RYBELSUS®
What is the most important information I should know about RYBELSUS®?
RYBELSUS® may cause serious side effects, including:

Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, RYBELSUS® and medicines that work like RYBELSUS® caused thyroid tumors, including thyroid cancer. It is not known if RYBELSUS® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people
Do not use RYBELSUS® if:

you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
you have had a serious allergic reaction to semaglutide or any of the ingredients in RYBELSUS®. See symptoms of serious allergic reaction in “What are the possible side effects of RYBELSUS®?”
What is RYBELSUS®?
RYBELSUS® (semaglutide) tablets 7 mg or 14 mg is a prescription medicine used along with diet and exercise to improve blood sugar (glucose) in adults with type 2 diabetes.

RYBELSUS® is not for use in people with type 1 diabetes
It is not known if RYBELSUS® is safe and effective for use in children
Important Safety Information
Before using RYBELSUS®, tell your healthcare provider if you have any other medical conditions, including if you:

have or have had problems with your pancreas or kidneys
have a history of vision problems related to your diabetes
are scheduled to have surgery or other procedures that use anesthesia or deep sleepiness (deep sedation)
are pregnant or plan to become pregnant. It is not known if RYBELSUS® will harm your unborn baby. You should stop using RYBELSUS® 2 months before you plan to become pregnant
are breastfeeding or plan to breastfeed. Breastfeeding is not recommended during treatment with RYBELSUS®
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. RYBELSUS® may affect the way some medicines work and some medicines may affect the way RYBELSUS® works.

How should I take RYBELSUS®?
Take RYBELSUS® exactly as your healthcare provider tells you to
Do not take more than 1 tablet each day
Take RYBELSUS® by mouth on an empty stomach in the morning with a sip of plain water (no more than 4 ounces). Do not take RYBELSUS® with any other liquids besides water
Do not split, crush, or chew. Swallow RYBELSUS® whole
After 30 minutes, you can eat, drink, or take other oral medicines
If you miss a dose of RYBELSUS®, skip the missed dose and go back to your regular schedule
What are the possible side effects of RYBELSUS®?
RYBELSUS® may cause serious side effects, including:

inflammation of your pancreas (pancreatitis). Stop using RYBELSUS® and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back
changes in vision. Tell your healthcare provider if you have changes in vision during treatment with RYBELSUS®
low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use RYBELSUS® with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include: dizziness or lightheadedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, and feeling jittery
kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration
severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use RYBELSUS®. Tell your healthcare provider if you have stomach problems that are severe or will not go away
serious allergic reactions. Stop using RYBELSUS® and get medical help right away, if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat
gallbladder problems. Gallbladder problems have happened in some people who take RYBELSUS®. Tell your healthcare provider right away if you get symptoms of gallbladder problems, which may include: pain in your upper stomach (abdomen), yellowing of skin or eyes (jaundice), fever, and clay-colored stools
food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sleepiness (deep sedation). RYBELSUS® may increase the chance of food getting into your lungs during surgery or other procedures. Tell all your healthcare providers that you are taking RYBELSUS® before you are scheduled to have surgery or other procedures
The most common side effects of RYBELSUS® may include nausea, stomach (abdominal) pain, diarrhea, decreased appetite, vomiting, and constipation. Nausea, vomiting, and diarrhea are most common when you first start RYBELSUS®.

Please see Prescribing Information and Medication Guide for RYBELSUS®.

RYBELSUS® is a prescription medication.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.

  
Important Safety Information for Ozempic®
Do not share your Ozempic® pen with other people, even if the needle has been changed. You may give other people a serious infection or get a serious infection from them.

What is the most important information I should know about Ozempic®?
Ozempic® may cause serious side effects, including:

Possible thyroid tumors, including cancer. Tell your health care provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Ozempic® and medicines that work like Ozempic® caused thyroid tumors, including thyroid cancer. It is not known if Ozempic® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.
Do not use Ozempic® if you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
What is Ozempic®?
Ozempic® (semaglutide) injection 0.5 mg, 1 mg, or 2 mg is an injectable prescription medicine used:

along with diet and exercise to improve blood sugar (glucose) in adults with type 2 diabetes.
to reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes with known heart disease.
to reduce the risk of kidney disease worsening, kidney failure (end-stage kidney disease), and death due to cardiovascular disease in adults with type 2 diabetes and chronic kidney disease.
It is not known if Ozempic® is safe and effective for use in children.

Important Safety Information
Do not use Ozempic® if:
you or any of your family have ever had MTC or if you have MEN 2.
you are allergic to semaglutide or any of the ingredients in Ozempic®. See symptoms of serious allergic reaction in “What are the possible side effects of Ozempic®?”.
Before using Ozempic®, tell your health care provider if you have any other medical conditions, including if you:
have or have had problems with your pancreas.
have a history of diabetic retinopathy.
have severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis) or problems with digesting food.
are scheduled to have surgery or other procedures that use anesthesia or deep sleepiness (deep sedation).
are pregnant or breastfeeding or plan to become pregnant or breastfeed. It is not known if Ozempic® will harm your unborn baby or pass into your breast milk. You should stop using Ozempic® at least 2 months before you plan to become pregnant.
Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements, and other medicines to treat diabetes, including insulin or sulfonylureas.

What are the possible side effects of Ozempic®?
Ozempic® may cause serious side effects, including:

inflammation of your pancreas (pancreatitis). Stop using Ozempic® and call your health care provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.
changes in vision. Tell your health care provider if you have changes in vision during treatment with Ozempic®.
low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use Ozempic® with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include: dizziness or lightheadedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, and feeling jittery.
dehydration leading to kidney problems. Diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems. It is important for you to drink fluids to help reduce your chance of dehydration. Tell your health care provider right away if you have nausea, vomiting, or diarrhea that does not go away.
severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use Ozempic®. Tell your health care provider if you have stomach problems that are severe or will not go away.
serious allergic reactions. Stop using Ozempic® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.
gallbladder problems. Gallbladder problems have happened in some people who take Ozempic®. Tell your healthcare provider right away if you get symptoms which may include: pain in your upper stomach (abdomen), fever, yellowing of the skin or eyes (jaundice), or clay-colored stools.
food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sleepiness (deep sedation). Ozempic® may increase the chance of food getting into your lungs during surgery or other procedures. Tell all your healthcare providers that you are taking Ozempic® before you are scheduled to have surgery or other procedures.
The most common side effects of Ozempic® may include nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation.

Please see Prescribing Information and Medication Guide for Ozempic®.

Ozempic® is a prescription medication.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.