*Indicates required field.
What would you like to do?*
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?a (Examples include Medicare, Medigap, VA, DOD, TRICARE, Medicaid, or any other state or federal medical/pharmaceutical benefit or assistance program)*
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.
Tell us about yourself
Confirmation
Registration is not complete until you indicate if you agree to the following statements.
I agree*
I agree
Tell us about your treatment
To help tailor your support experience, please provide us with some basic information about how you're currently managing your type 2 diabetes.
Are you currently taking Ozempic®?*
Yes
No
What formulation of Ozempic® are you taking or have been prescribed?*
Ozempic® pen
Ozempic® pill
How long have you been taking Ozempic®?*
<4 weeks
>4 weeks
Would you like to receive text messages about Ozempic®?*
Please enter your phone number
Your personal health data may be shared by your pharmacy with Novo Nordisk and its partners. Once shared, you understand HIPAA may no longer protect your data. You do not need to answer “I agree” to get the Savings Offer.
Please review the full waiver.
Do you understand and agree to this data share?
I disagree
You can also print or download the offer or email it to a different email address.
Print or download offer
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.
Send the savings offer to another email address.