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*Indicates required field.

What would you like to do?*

I need a new or a replacement offer

I need to activate an offer that I received

Enter a 10-digit group (GRP) number from the front of the offer*

Enter an 11-digit ID number from the front of the offer*

Are you enrolled in insurance from any government, state, or federally funded medical or prescription benefit programs?^b
(Examples include Medicare, Medigap, VA, DOD, TRICARE, Medicaid, or any other state or federal medical/pharmaceutical benefit or assistance program)*

Yes

No

^bIndividuals with both commercial and government-funded plans ARE considered patients with government insurance. If you should begin to receive prescription benefits under any government insurance plan, you understand that you can no longer participate in this savings program.

Note: The Federal Employees Health Benefits (FEHB) Program, Affordable Care (Health Exchange) Plans, and insurance provided through state employee plans are NOT federal or state government health care programs for purposes of this savings offer.

We’re sorry, but you are not eligible to participate in this program because you are currently enrolled in a government, state, or federally funded prescription benefit program. However, there may be additional options.

See if you're eligible for our Patient Assistance Program (PAP)

*Indicates required field.

Tell us about yourself

First name*

Last name*

Email address*

Date of birth*

Zip code*

*Indicates required field.

Tell us about your treatment

To help tailor your support experience, we need to know some basic information about how your type 2 diabetes is being treated.

How long have you been on Ozempic^®?*

Less than 4 weeks

More than 4 weeks 

I’m not currently on Ozempic^®

*Indicates required field.

Confirmation

Registration is not complete until you indicate if you agree to each of the following statements

agreeConsent

I agree*

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aboveEighteenYear

I agree and confirm I am 18 years of age or older

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Collection_Point

Ozempic_P_COPAY_SAVINGS

Ozempic_Communications

Ozempic_Corporate_Communications

Corporate_Communications

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NEXT: Get savings offer

We sent the savings offer to the email address you provided

You can also print or download the offer, or email it to a different email address.
 

Print offer

Download offer

Print or download offer

Email offer

A PDF of the offer should have opened in a separate browser window.

You can view the offer and print from that window.

If you have questions about the savings offer, please call 1-877-304-6855. Open 24 hours a day, 7 days a week.

A PDF of the offer was automatically downloaded to your device.

If you have questions about the savings offer, please call 1-877-304-6855. Open 24 hours a day, 7 days a week.

The offer has been sent to the email address you provided.

Send the savings offer to another email address.

Enter email address

Enter email address

Send

If you have questions about the savings offer, please call 1-877-304-6855. Open 24 hours a day, 7 days a week.

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applicationId

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