A couple short steps and you're on your way
to seeing your FlexPen® co-pay. What are you waiting for?

What health insurance plan do you have?

Private health insurance

Medicare, including Medicare Part D, or Medicaid

None? Find out if Prescription Assistance (PPA) can help.

STEP 1 OF 3

*Policyholder First Name	*Policyholder Last Name
*Policyholder Zip Code	*Patient Relationship To Policyholder

*Patient Date of Birth

*Patient Gender:

If you need help locating this important information from your health insurance card please
call 1-877-821-3499 (toll free) between 8AM-6PM for free, confidential assistance.

*Required

A couple short steps and you're on your way
to seeing your FlexPen® co-pay. What are you waiting for?

With ,
expect to pay per prescription^*:

*Co-pay subject to change.

For further savings…

No insurance? Perhaps PPA can help.

The Partnership for Prescription Assistance (PPA) helps patients without prescription
drug coverage get the medicines they need for free or nearly free.

To see if you're qualified, visit pparx.org or call 1-888-4PPA-NOW.

Take a Closer Look at NovoLog^® Mix 70/30

A couple short steps and you're on your way to seeing your FlexPen® co-pay. What are you waiting for?

With , expect to pay per prescription*:

*Co-pay subject to change.

For further savings…

No insurance? Perhaps PPA can help.

The Partnership for Prescription Assistance (PPA) helps patients without prescription drug coverage get the medicines they need for free or nearly free.

To see if you're qualified, visit pparx.org or call 1-888-4PPA-NOW.

Take a Closer Look at NovoLog® Mix 70/30

A couple short steps and you're on your way
to seeing your FlexPen® co-pay. What are you waiting for?

With ,
expect to pay per prescription^*:

The Partnership for Prescription Assistance (PPA) helps patients without prescription
drug coverage get the medicines they need for free or nearly free.

Take a Closer Look at NovoLog^® Mix 70/30