Novo Nordisk values your privacy and your personal information, which we will need to collect from you as we determine eligibility, enrollment, and/or activation of the Novo Nordisk Wegovy Savings Offer. You can learn more about your privacy rights at www.novonordisk-us.com/disclaimer-privacy.html. Do you understand that you are releasing your name and email address to Novo Nordisk and agents working on its behalf in order to assist you with the Novo Nordisk Wegovy Savings Offer?
Novo Nordisk values your privacy and the security of your personal information, which we will need to collect from you for the sole purpose of determining your eligibility, enrollment, and/or activation of the [Novo Nordisk Wegovy Savings Offer] along with other purposes to aid you in your Wegovy journey. Specifically, if you are deemed eligible for a Savings Card, you understand that certain information pertaining to your use of the Savings Card may be shared by my pharmacy with Novo Nordisk, the sponsor of the Card. The information disclosed will include the date a prescription was filled, the amount of medication dispensed by the pharmacist, and potentially the amount reimbursed by Novo Nordisk. This information may be used by Novo Nordisk to provide you with information about your prescription along with critical analytics for Novo Nordisk to make program improvements to the Novo Nordisk Wegovy Savings Offer. Should you begin receiving prescription benefits from a federal, state, or other government-funded program at any time, you will no longer be eligible to participate in this program. You can learn more about your privacy rights at www.novonordisk-us.com/disclaimer-privacy.html.
Do you understand that you are releasing only the minimally necessary information, including first name, last name, and status as a patient or caregiver (along with the other general information mentioned) to Novo Nordisk and authorized agents working on its behalf in order to assist you with the Novo Nordisk Wegovy Savings Offer?
Live Op Rep: Welcome! To get started, let’s check the patient’s eligibility.
1.*
Is the patient enrolled in any government, state, or federally funded medical or prescription benefit programs? This includes Medicaid, Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program, collectively referred to as Government Programs herein, or where prohibited by law.
Does the patient have insurance from any government, state, or federally funded medical or prescription benefit programs, such as, Medicare, Medigap, VA, DOD, TRICARE, Medicaid or any similar federal or state health care program. A patient who has both commercial and government plans is considered a patient with government insurance. Please note that if the patient should begin to receive prescription benefits under any government insurance plan that patient can NO longer participate in this savings program.
2.*
Does the patient have commercial (also known as private) insurance? (Example: Insurance provided through an employer)
Does the patient have commercial (also known as private) insurance (Insurance provided through an employer) OR are they uninsured?
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As the patient or as the caregiver responding on behalf of the patient, do you confirm you are 18 years of age or older, are a US resident and agree to the Terms & Conditions of this offer.The Terms & Conditions may be found at www.wegovyterms.com The Terms & Conditions for your corresponding offer may be found at www.wegovyterms2021.com or www.gettoknowwegovyterms.com
As the patient or as the caregiver responding on behalf of the patient, please listen carefully to the following statements and make a selection:
You are eligible for the Copay Card, if you are the patient and affirm you are 18 years or older, are a US resident and agree to the Terms & Conditions of this offer. The Terms & Conditions may be found at www.wegovyterms.com.
You are eligible for the Copay Card, if you are the caregiver, calling on behalf of the patient and affirm you are 18 years or older, are a US resident and agree to the Terms & Conditions of this offer. The Terms & Conditions may be found at www.wegovyterms.com.
Live Op Rep: At this time, I just need to collect some information off your savings card in order to start the activation process.
4.*
What is the 11-digit ID number found on the front of your card?
Live Op Rep: I am now going to ask you a few questions to complete the activation of your card.
4.*
5.*
What is the patient’s first name?
5.*
6.*
What is the patient’s last name?
7.
What is the patient’s Email address? (It is ok if they don’t have one.)
6.
You have the option to receive your Wegovy Copay Card via SMS text message if you so choose. This is not a requirement and simply an optional service, and your decision will not in any way affect your eligibility and/or enrollment. If you would like to receive your copay card via SMS text message, please provide your 10-digit mobile phone number beginning with your area code. Please note that message and data rates may apply. (It is ok if they don’t have one.)
Please read the DATA OPT-IN (Med Act) language below, word for word.
Thank you for your time. To finish the activation of your Novo Nordisk Wegovy Savings Offer, please listen to the following brief statements. We will ask you to accept the terms before continuing.
If eligible, I understand that certain information pertaining to my use of the Card will be shared by my pharmacy with Novo Nordisk, the sponsor of the Card. The information disclosed will include the date I filled the prescription, amount of medication dispensed by my pharmacist, and amount I will be reimbursed by Novo Nordisk. This information may be used by Novo Nordisk to provide me with information about my prescription. Should I begin receiving prescription benefits from a federal, state, or other government-funded program at any time, I will no longer be eligible to participate in this program. You may contact me periodically in order to verify that my eligibility for the program has not changed.
Do you agree with these terms?
Please make a selection.
Please read the MARKETING OPT-IN language below, word for word.
To complete your registration, please listen carefully to this information to better understand how Novo Nordisk uses the information you provided us. When you finish, please select an option and confirm your age.
Novo Nordisk respects the importance of your privacy and understands your health is a very personal and sensitive subject. Novo Nordisk wants you to understand how it will use the information provided by you on this registration page.By selecting “I Agree”, you are indicating you want to learn more about this service and receive promotional or non-promotional updates via email or mail from Novo Nordisk or its partners about products, support services, or other special opportunities that Novo Nordisk or its partners believe might be interesting to you. You also understand that you may opt out from receiving any future communications from Novo Nordisk or its partners by clicking the “unsubscribe” link within any email you receive, by calling 1.877.744.2579, or by sending us a letter containing your full contact information (e.g. name, email address, phone) to Novo Nordisk, 800 Scudders Mill Road, Plainsboro, New Jersey 08536.
To better understand how Novo Nordisk values your privacy and what other information may be collected from you while you use this service, please see our Privacy Statement at www.novonordisk-us.com.
I agree and confirm I am 18 years of age or older.