Bottom line
Patient Assistance Programs (PAPs) provide GLP-1 medications at no cost to qualifying patients who cannot afford them. Novo Nordisk (NovoCare PAP) and Eli Lilly (Lilly Cares) both offer programs with income-based eligibility — generally requiring household income at or below 200–400% of the federal poverty level. Applications require physician involvement, income documentation, and typically take 2–4 weeks for approval. These programs are separate from manufacturer savings cards and serve different populations: PAPs help uninsured or underinsured patients, while savings cards reduce copays for commercially insured patients.
Understanding patient assistance programs
What PAPs are
Patient Assistance Programs are manufacturer-sponsored programs that provide brand-name medications at no cost to patients who meet specific income and insurance criteria. They exist because federal law requires pharmaceutical manufacturers to make medications accessible to low-income patients, and because manufacturers gain tax benefits and goodwill from these programs.
Who PAPs are designed for
PAPs target patients who:
- Have no health insurance at all
- Have Medicare but lack Part D coverage or have a coverage gap
- Have insurance that does not cover the specific medication
- Cannot afford their copay or coinsurance even with insurance
PAPs are NOT for patients with commercial insurance who simply have a high copay — those patients should use manufacturer savings cards instead (see our guide on [guide:glp1-manufacturer-savings-programs]).
PAPs vs. savings cards: key differences
| Feature | Patient Assistance Program | Manufacturer Savings Card | |---|---|---| | Cost to patient | $0 (free medication) | $25+ copay | | Target population | Uninsured or Medicare | Commercially insured | | Income verification | Yes (documentation required) | No | | Physician involvement | Required (must sign application) | Not required | | Approval time | 2–4 weeks | Instant | | Government insurance OK | Yes (Medicare eligible for most) | No | | Annual re-enrollment | Yes | Yes |
NovoCare Patient Assistance Program (Novo Nordisk)
Medications covered
The NovoCare PAP covers multiple Novo Nordisk medications including:
- Ozempic (semaglutide for type 2 diabetes)
- Wegovy (semaglutide for weight management)
- Saxenda (liraglutide for weight management)
- Various insulin products
Eligibility requirements (as of 2026)
Income thresholds:
- For Ozempic: Total household income at or below 200% of the Federal Poverty Level (FPL)
- For Wegovy and other medications: Total household income at or below 400% of the Federal Poverty Level
2026 Federal Poverty Level reference (continental U.S.):
| Household size | 200% FPL | 400% FPL | |---|---|---| | 1 person | ~$30,120 | ~$60,240 | | 2 persons | ~$40,880 | ~$81,760 | | 3 persons | ~$51,640 | ~$103,280 | | 4 persons | ~$62,400 | ~$124,800 |
Note: FPL figures are updated annually. Check novocare.com for current thresholds.
Insurance requirements:
- Must have Medicare OR no insurance
- If you have commercial/private insurance, you are NOT eligible for the PAP (use the savings card instead)
- Must NOT be enrolled in or eligible for Medicaid, Medicare Low Income Subsidy (LIS), or VA benefits
Important 2026 change: Medicare beneficiaries with Part D coverage are no longer eligible to receive Ozempic through the Patient Assistance Program, due to the expanding Medicare GLP-1 Bridge and BALANCE programs expected to launch mid-2026.
How to apply
Step 1: Get your prescriber involved Your healthcare provider must complete and sign the application. The PAP requires a prescriber's attestation that the medication is medically necessary.
Step 2: Gather documentation
- Most recent federal tax return (1040) showing adjusted gross income
- OR two recent pay stubs if you do not file taxes
- Proof of insurance status (Medicare card, or documentation of no coverage)
- A valid prescription for the specific medication
Step 3: Submit the application Applications can be submitted:
- Online at novocare.com
- By fax to the NovoCare PAP processing center
- By mail
Step 4: Wait for approval Processing typically takes 2–4 weeks. During this time, NovoCare verifies income documentation and eligibility.
Step 5: Receive medication Once approved, medication is shipped directly to your prescriber's office or to your home (depending on the medication). You pick it up from your doctor's office or receive it by mail.
Re-enrollment
PAP approval is typically valid for 12 months. You must re-enroll annually with updated income documentation. Set a calendar reminder 6–8 weeks before expiration to allow processing time.
Lilly Cares Foundation (Eli Lilly)
Medications covered
Lilly Cares covers:
- Mounjaro (tirzepatide for type 2 diabetes)
- Zepbound (tirzepatide for weight management)
- Trulicity (dulaglutide for type 2 diabetes)
- Various insulin products
Eligibility requirements
Income thresholds:
- Household annual adjusted gross income at or below 300% of the Federal Poverty Level
2026 Federal Poverty Level reference (300% FPL):
| Household size | 300% FPL | |---|---| | 1 person | ~$45,180 | | 2 persons | ~$61,320 | | 3 persons | ~$77,460 | | 4 persons | ~$93,600 |
Note: These are approximate figures. Check lillycares.com for current thresholds.
Insurance requirements:
- Must have no insurance OR have Medicare Part D
- Patients with commercial insurance are NOT eligible (use the Mounjaro or Zepbound savings card instead)
- Must not be eligible for Medicaid or other government programs (other than Medicare)
How to apply
Step 1: Visit lillycares.com Download the application form or start the process online.
Step 2: Complete the application The application requires:
- Patient information (name, address, date of birth)
- Prescriber information and signature
- A valid prescription for the specific medication
- Income documentation (tax return or pay stubs)
- Insurance status documentation
Step 3: Prescriber signs and submits Your doctor must sign the application attesting to medical necessity. Many prescriber offices are familiar with PAP applications and can handle submission for you.
Step 4: Wait for processing Lilly Cares processing typically takes 2–4 weeks. You will receive a notification of approval or denial by mail.
Step 5: Receive medication Approved patients receive medication shipped to their prescriber's office. Some medications may be shipped directly to the patient.
Re-enrollment
Lilly Cares requires annual re-enrollment with updated income and insurance documentation.
State pharmaceutical assistance programs
What SPAPs are
State Pharmaceutical Assistance Programs (SPAPs) are state-run programs that help residents afford prescription medications. As of 2026, approximately 13 states operate SPAPs, down from 23 in 2004. These programs typically coordinate with Medicare Part D to provide supplemental coverage.
How SPAPs work with GLP-1s
SPAPs can layer on top of Medicare Part D to cover copays or provide additional prescription drug benefits. Whether a specific SPAP covers GLP-1 medications depends on the state's formulary and program rules.
States with active SPAPs (as of 2026)
Programs vary significantly by state. Check your state's program for specific formulary coverage:
- Connecticut (ConnPACE)
- Delaware (DPAP)
- Illinois (various programs)
- Indiana (HoosierRx)
- Maine (Drugs for the Elderly)
- Maryland (MPDAP)
- Massachusetts (Prescription Advantage)
- Montana (Big Sky Rx)
- New Jersey (PAAD/Senior Gold)
- New York (EPIC)
- Pennsylvania (PACE/PACENET)
- Vermont (VPharm)
- Wisconsin (SeniorCare)
Contact your state's program directly to determine whether GLP-1 medications are covered and what eligibility requirements apply.
Nonprofit and charitable assistance
NeedyMeds
NeedyMeds (needymeds.org) is a nonprofit that aggregates information about patient assistance programs, discount cards, and charitable drug programs. Their database is searchable by medication name and can help you find programs you may not know about. They also offer a free drug discount card and a helpline (1-800-503-6897).
PAN Foundation
The Patient Access Network (PAN) Foundation occasionally opens funds for specific disease categories that may include diabetes or obesity medications. Fund availability changes frequently — check panfoundation.org regularly.
HealthWell Foundation
The HealthWell Foundation provides copay assistance for various conditions. GLP-1 coverage availability varies. Check healthwellfoundation.org for current open funds.
Good Days (formerly CDF)
Good Days provides financial assistance for prescription medications. Check mygooddays.org for current GLP-1 fund availability.
Key limitations of nonprofit assistance
- Funds open and close unpredictably based on donations
- Annual caps on assistance (often $5,000–$15,000 per patient per year)
- May require specific diagnoses (type 2 diabetes, obesity) with documentation
- Waitlists are common for popular medications
- Most require annual re-enrollment
The application process: what to expect
Timeline
| Step | Typical duration | What happens | |---|---|---| | Gather documents | 1–2 weeks | Collect tax returns, insurance cards, prescription | | Complete application | 1–2 days | Fill out forms with prescriber | | Prescriber review and signature | 1–7 days | Doctor signs and submits | | Processing | 2–4 weeks | Manufacturer verifies eligibility | | Approval notification | 1–3 days after processing | Letter or call confirming status | | First shipment | 1–2 weeks after approval | Medication arrives at doctor's office or home | | Total time | 4–8 weeks | From start to receiving medication |
What to do while waiting
The 4–8 week gap between application and first medication delivery is a genuine problem. Options during the wait:
- Ask your prescriber for samples (many offices have starter supplies)
- Use a manufacturer savings card if you have any commercial insurance
- Check if your prescriber can submit an expedited application (some PAPs offer rush processing for urgent cases)
- Use GoodRx or similar discount cards at retail pharmacies as a temporary bridge
Common reasons for denial
- Household income exceeds the threshold
- Eligible for Medicaid or other government programs you have not enrolled in
- Incomplete documentation (most common — ensure all forms are fully completed)
- Commercial insurance that covers the medication (redirect to savings card)
- Missing prescriber signature
If your application is denied
1. Review the denial letter for the specific reason 2. If income-related, check if you miscalculated household size or income 3. If insurance-related, verify whether your coverage actually includes the medication 4. Appeal the decision if you believe it was made in error 5. Explore alternative programs (other PAPs, SPAPs, nonprofit foundations)
New programs launching in 2026
Medicare GLP-1 Bridge
CMS is launching a Medicare GLP-1 Bridge program expected to provide Part D beneficiaries access to GLP-1 medications by mid-2026. This short-term demonstration may reduce or eliminate the need for PAPs among Medicare patients.
BALANCE Model (Medicaid)
The CMS BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive Health) Model is launching in Medicaid as early as May 2026, potentially providing GLP-1 access to Medicaid beneficiaries in participating states.
These programs may significantly change the PAP landscape for government-insured patients. Check cms.gov for updates on enrollment and state participation.
Tips for successful PAP applications
Do
- Apply as soon as you learn you cannot afford your medication (processing takes weeks)
- Have your prescriber's office help with the application — they often have dedicated staff familiar with PAP submissions
- Include all requested documentation the first time (incomplete applications are the most common cause of delays)
- Keep copies of everything you submit
- Set calendar reminders for annual re-enrollment
- Apply to multiple programs simultaneously if eligible (some patients qualify for both manufacturer and nonprofit programs)
Do not
- Wait until you run out of medication to apply (start 6–8 weeks before you anticipate needing it)
- Submit without your prescriber's signature (instant rejection)
- Provide estimated income — use actual tax return figures
- Assume you do not qualify — apply even if you are close to the income threshold (household size affects eligibility significantly)
- Give up after one denial — explore alternative programs
Quick reference: which program is right for you?
| Your situation | Best program | Where to start | |---|---|---| | Commercial insurance, high copay | Manufacturer savings card | novocare.com or lilly.com | | No insurance, income under 400% FPL | Manufacturer PAP | novocare.com/pap or lillycares.com | | Medicare Part D, income under 300% FPL | Lilly Cares or NovoCare PAP | lillycares.com or novocare.com/pap | | Medicaid | BALANCE Model (2026) | Check state Medicaid office | | Medicare, launching mid-2026 | Medicare GLP-1 Bridge | cms.gov | | Any situation, need help finding programs | NeedyMeds | needymeds.org |
Consult your healthcare provider or a social worker at your clinic if you need help navigating these programs. Many health systems have financial counselors who specialize in connecting patients with assistance programs.
[guide:glp1-manufacturer-savings-programs] · [guide:best-glp1-programs-2026] · [drug:semaglutide] · [drug:tirzepatide]