Xultophy is one of the more paperwork-heavy medications on the Novo Nordisk assistance formulary, and it's not because the drug itself is unusual. It's because Xultophy is a combination product — one daily injection pen that delivers both a basal insulin and a GLP-1 medication that Novo Nordisk also sells separately.
That combination is exactly why patients and providers get tripped up on the Patient Assistance Program application. The income rules are standard. What's different is a documentation step most other insulin applications don't need: proving the combination itself is medically necessary.
This guide walks through what the 2026 Xultophy PAP actually requires, why that extra documentation exists, and how Xultophy stacks up against getting its two components separately.
What Is Xultophy and Why the PAP Matters
Xultophy combines insulin degludec (the active ingredient in Tresiba) and liraglutide (the active ingredient in Victoza) in a single fixed-ratio pen, injected once daily. It's approved for adults with Type 2 diabetes who need both a basal insulin and a GLP-1 receptor agonist to manage blood sugar.
For patients who need both drug classes, combining them into one injection means fewer needle sticks and one prescription to manage instead of two. Without insurance, though, it's also an expensive specialty product, which is where the PAP comes in.
Why this matters: Patients on multi-drug insulin regimens are at higher risk of skipping doses when cost becomes a barrier. The PAP exists specifically to prevent that kind of rationing.
What Is the Novo Nordisk PAP (NovoCare)?
NovoCare is Novo Nordisk's patient support division. It runs three related programs, and knowing which one applies saves time.
| Program | Who It's For | What It Does |
|---|---|---|
| Patient Assistance Program (PAP) | Uninsured/underinsured, income-eligible patients | Provides Xultophy at $0 cost |
| Novo Nordisk Savings Card | Patients with eligible commercial insurance | Reduces monthly copay |
| Insurance Navigation | Anyone needing help with coverage or appeals | Assists with prior authorizations and formulary appeals |
General PAP support: 1-866-310-7549 (Mon–Fri, 8am–8pm ET). Savings card support: 1-844-465-4262. Delivery questions go to Neovance Specialty Pharmacy at 1-800-488-5908.
Xultophy PAP Eligibility at a Glance
You're a strong candidate for the Xultophy PAP if the following apply:
- You are a U.S. resident currently prescribed Xultophy by a licensed prescriber.
- You have no prescription drug coverage, or you have Medicare without adequate coverage for Xultophy.
- Your household income falls at or below 400% of the federal poverty level.
- Your prescriber is willing to document why combination therapy is medically necessary and sign the prescriber section.
You're less likely to qualify if:
- You have commercial insurance that already covers Xultophy at a reasonable copay.
- Your household income is above the 400% FPL threshold.
- You have Medicaid, which typically already covers Xultophy.
- Your application lacks the medical necessity justification for combination therapy.
Income Limits for Xultophy Assistance (2026)
Xultophy falls under the PAP's standard 400% federal poverty level threshold — the same ceiling used for most other Novo Nordisk diabetes medications, as opposed to Ozempic's stricter 200% FPL limit.
| Household Size | Annual Income Limit (400% FPL) |
|---|---|
| 1 Person | ~$62,600 |
| 2 People | ~$84,600 |
| 3 People | ~$106,600 |
| 4 People | ~$128,600 |
| 5 People | ~$150,600 |
| 6 People | ~$172,600 |
| 7 People | ~$194,600 |
| 8 People | ~$216,600 |
Alaska and Hawaii use higher thresholds. For households larger than 8, add roughly $22,000 per additional person to the limit above.
Xultophy vs. Its Individual Components Compared
Because Xultophy is built from two drugs Novo Nordisk also sells on their own, it's worth understanding what changes — and what doesn't — if you get the combination instead of the two separate prescriptions.
| Feature | Xultophy (combined) | Tresiba + Victoza (separate) |
|---|---|---|
| Daily injections | One | Two |
| PAP income limit | 400% FPL | 400% FPL (each) |
| PAP cost if approved | $0 | $0 |
| Prescriptions to renew | One | Two, potentially on different cycles |
| Dose flexibility | Fixed ratio between the two drugs | Each dose adjusted independently |
| PAP documentation needed | Medical necessity justification for the combination | Standard prescriber section only |
Neither option costs more than the other once approved through the PAP — the real trade-off is convenience versus dosing flexibility. Patients whose insulin and GLP-1 doses need to move independently are often better candidates for the separate prescriptions; patients on a stable, well-matched dose of both often prefer the single injection.
The Combination Therapy Documentation Requirement
This is the step that trips up more Xultophy applications than anything else. Because insulin degludec and liraglutide are each available as standalone, individually PAP-eligible medications, Novo Nordisk requires the prescriber to explain, in the prescriber section, why the fixed-ratio combination is the appropriate choice instead of two separate prescriptions.
What this looks like in practice: Your prescriber typically needs to note something specific — for example, improved adherence with a single injection, a dose ratio that matches the fixed combination well, or difficulty managing two separate insulin/GLP-1 regimens. A generic "patient has Type 2 diabetes" note is usually not sufficient on its own.
If your prescriber's office is unfamiliar with this requirement, ask them to call NovoCare directly at 1-866-310-7549 before submitting — confirming the documentation format up front avoids a round trip.
Xultophy Savings Card vs Patient Assistance Program
These two programs solve different problems, and mixing them up is a common reason applications are misdirected.
| Feature | Patient Assistance Program | Novo Nordisk Savings Card |
|---|---|---|
| Best for | Uninsured or underinsured patients | Commercially insured patients |
| Cost | $0 | Reduced monthly copay |
| Income limit | 400% FPL | None |
| Medicare/Medicaid eligible? | Medicare: case-by-case; Medicaid: usually no | No — federal law prohibits |
| Combination therapy documentation needed? | Yes | No |
Bottom line: If you have commercial insurance that already covers Xultophy, the savings card is faster and skips both the income verification and the combination therapy documentation the PAP requires. Call NovoCare at 1-844-465-4262 to check current savings card terms for your plan.
Insurance Status Requirements
| Insurance Situation | Typically Eligible for the PAP? |
|---|---|
| No health insurance at all | Usually Yes |
| Insurance with no prescription drug benefit | Usually Yes |
| Medicare Part D with Xultophy excluded or unaffordable | Case-by-Case |
| Commercial insurance that already covers Xultophy | Usually No — savings card instead |
| Medicaid | Usually No — Medicaid typically covers Xultophy |
If you're navigating Medicare specifically, our Medicare Part D guide and Extra Help (LIS) explainer cover how those programs interact with manufacturer assistance.
Required Documents
| Document | Who Needs It | Purpose |
|---|---|---|
| Completed patient section | Everyone | Identity, household size, income, insurance status |
| Completed prescriber section with combination therapy justification | Everyone | Confirms diagnosis and why Xultophy specifically is needed |
| Proof of income | Everyone | Recent tax return, pay stubs, or Social Security statement |
| Proof of inadequate insurance | Insured applicants | Formulary exclusion letter or explanation of benefits showing high cost-sharing |
| Medicare Extra Help (LIS) denial | Medicare patients below 150% FPL | Proves you were denied the Low Income Subsidy |
| Valid prescription | Everyone | Confirms Xultophy and the prescribed dose |
Note: Xultophy applicants do not need a Medicaid denial letter unless your income also puts you near the Medicaid eligibility threshold in your state. That requirement is specific to Ozempic under the 2026 rules.
How to Apply, Step by Step
Confirm Xultophy — not the separate components — is what's prescribed
If your prescriber is still deciding between the combination pen and separate Tresiba/Victoza prescriptions, settle on the medication before starting the application.
Start the application online or by phone
Go to the NovoCare PAP portal or call 1-866-310-7549 to request a form.
Fill in the patient section
Enter your name, address, household size, income, and current insurance status exactly as it appears on your supporting documents.
Have your prescriber complete the section with combination therapy justification
This is the step unique to Xultophy — ask your prescriber's office to specifically address why the fixed-ratio combination is appropriate rather than separate prescriptions.
Attach income and insurance documentation
Include a recent tax return or pay stubs, plus documentation showing your insurance doesn't adequately cover Xultophy, or proof you have no coverage at all.
Submit and wait for a decision
Submit online for the fastest turnaround, or fax the completed packet to 1-866-364-6633.
Ready to apply?
Call NovoCare at 1-866-310-7549 (Monday–Friday, 8am–8pm ET), and make sure your prescriber's office is ready to document combination therapy necessity before submitting.
Go to NovoCare → See Required DocumentsDecision Tree: Is the PAP Right for You?
Step 1: Do you have commercial insurance that already covers Xultophy?
✔ Yes → Use the Novo Nordisk Savings Card instead.
✖ No → Continue to Step 2.
Step 2: Is your household income at or below 400% FPL for your household size?
✔ Yes → Continue to Step 3.
✖ No → The PAP likely isn't a fit; consider a disease-specific foundation or state pharmaceutical assistance program.
Step 3: Can your prescriber document why combination therapy is medically necessary?
✔ Yes → You're a strong PAP candidate — start the application.
✖ No → Discuss whether separate Tresiba and Victoza prescriptions might be a simpler PAP path instead.
How Long Approval Takes
| Situation | Typical Timeframe |
|---|---|
| Complete online application, all documents attached | 1–2 business days |
| Fax or mail submission | 7–10 business days |
| Missing combination therapy justification | Delayed until prescriber provides additional documentation |
| Renewal application | 1–3 weeks (submit 30 days before expiration) |
To check status, call 1-866-310-7549 with your confirmation number ready.
How Xultophy Is Delivered
| Step | What Happens |
|---|---|
| Approval | You and your prescriber receive written notification |
| Pharmacy call | Neovance Specialty Pharmacy calls at 1-800-488-5908 to schedule delivery |
| Shipment | Xultophy ships within 5 business days to your home address |
| Refills | Neovance contacts you when a refill is due; update address by calling 1-866-310-7549 |
Important: Xultophy requires temperature-controlled shipping. Someone needs to be available to receive the package promptly and refrigerate unopened pens right away.
Renewing Your Enrollment
Enrollment typically runs about 12 months. Since Xultophy is a maintenance medication most patients need indefinitely, missing your renewal window can create a dangerous gap in supply.
- Start renewal before your current enrollment period ends.
- Submit updated income documentation, even if your income hasn't changed.
- Confirm your prescriber's office still has your case on file, since renewal also requires a new signature and — again — the combination therapy justification.
- Report any change in insurance status right away, since gaining adequate coverage can end PAP eligibility mid-cycle.
Pros and Cons of Using the PAP for Xultophy
Pros
- Medication cost drops to $0 for approved patients
- No Medicaid denial letter required for uninsured applicants
- Home delivery with free shipping
- One combined injection instead of managing two separate insulin/GLP-1 prescriptions
- Fast turnaround once the combination therapy documentation is included
Cons
- Requires extra prescriber documentation most other PAP drugs don't need
- Fixed dose ratio offers less flexibility than adjusting insulin and GLP-1 doses separately
- Annual reapplication with fresh documentation, including the combination justification again
- Cannot ship to a local retail pharmacy for pickup
- Income limit excludes many middle-income households
Common Mistakes That Delay Applications
- Submitting the prescriber section without a specific justification for combination therapy
- Assuming the same documentation used for Tresiba or Victoza alone will work for Xultophy
- Prescriber section left blank or unsigned
- Income documentation that doesn't match the household size listed
- Outdated income documents older than the program's accepted window
- Renewal submitted after the enrollment period already lapsed
The single biggest cause of delay for Xultophy specifically is a prescriber section that reads like a standard insulin request instead of addressing the combination therapy question directly.
Real Patient Scenarios
Scenario: Uninsured patient struggling with two separate injections
A patient managing both basal insulin and a GLP-1 medication separately has been missing doses due to the complexity of two injection schedules. Their endocrinologist documents this adherence issue as the medical necessity for switching to Xultophy, supporting a smooth PAP approval.
Scenario: Newly diagnosed patient, prescriber unsure which path to take
A patient newly started on both insulin and a GLP-1 medication could go either route. Because their doses are still being titrated independently, their provider opts for separate Tresiba and Victoza prescriptions instead — avoiding the combination therapy documentation step for now and preserving dosing flexibility.
Scenario: Medicare patient with a formulary gap
A Medicare Part D enrollee finds Xultophy isn't on their plan's formulary and the off-formulary cost is unaffordable. With a formulary exclusion letter from their Part D plan attached to the application, this patient can be evaluated case-by-case for PAP eligibility.
What to Do If You're Denied
| Reason for Denial | Next Step |
|---|---|
| Income slightly above threshold | Explore nonprofit foundation grants or state pharmaceutical assistance programs |
| Missing combination therapy justification | Return to your prescriber's office to add specific documentation and resubmit |
| Existing adequate coverage | Use the Novo Nordisk Savings Card instead |
| Incomplete prescriber section | Return to your prescriber's office to complete the form |
Our Drug Price Checker and GoodRx vs. Inside Rx comparison are useful next steps if a manufacturer program isn't a fit, along with our broader insulin savings programs roundup for diabetes medications generally.