Glucagon Prescription Assistance Programs

Glucagon: Apply for prescription assistance below

If you are eligible, the programs below can help you afford GlucaGen Hypokit. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not or go to the program website.

Looking for a different medication?

Novo Nordisk Patient Assistance Program

(Program 1 of 1 — Scroll down to see them all )

Provided by: Novo Nordisk Pharmaceuticals, Inc.
PO Box 370 Somerville, NJ 08876
TEL: 866-310-7549
ALT PHONE: 866-310-7549
FAX: 866-441-4190
Languages Spoken:
English, Spanish
Program Website
  • GlucaGen Hypokit (glucagon)
Eligibility Requirements
  • Insurance Status Must be uninsured
  • Those with Part D Elibible? *See Additional Information Section Below
  • Income At or below 400% of FPL
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must be a US citizen or legal resident.
  • Obtaining Call or download
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application must be faxed or mailed from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe 2 business days, once application process is complete
  • Amount/Supply Up to 120 day supply
  • Sent To Doctor's office
  • Delivery Time Within 7-10 business days
  • Refill Proces Reorder form needs to be submitted
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
This program also provides copay assistance. *Medicare Part D enrollment deadline is November 30 of each year.
Updated November 12, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

Back to top

Sign up for PharmacyChecker News

Exclusive drug savings tips & news straight to your inbox.

PharmacyChecker uses cookies to track & improve your online experience.