Vagifem Prescription Assistance Programs

Vagifem: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Vagifem. 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 Hormone Therapy

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

Provided by: Novo Nordisk Pharmaceuticals, Inc.
PO Box 181640 Louisville, KY 40261
TEL: 888-868-9852
FAX: 888-868-9853
Languages Spoken:
English, Others By Translation Service
Program Website
  • Vagifem (estradiol)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? No
  • Income At or below 200% of FPL
  • Diagnosis/Medical Criteria Not required
  • U.S. Residency Required? Must be US citizen or permanent resident residing in the US or US territories and treated by a US licensed doctor.
  • Obtaining Call or download
  • Receiving Faxed or mailed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach prescription
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient notified in writing
  • Decision Timeframe 7-10 business days
  • Amount/Supply Varies
  • Sent To Doctor's office
  • Delivery Time Within 3-5 business days
  • Refill Proces New application
  • Limit Up to 12 months of medication for each calendar year
  • Re-application New application needed for each refill
Additional Information
Patient Assistance Program questions are provided by Cornerstones4Care.
Updated March 19, 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.

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