For US residents only.

Novartis Oncology Universal Co-pay Program

In order to enroll in this program, please select your medication, read the Terms and Conditions carefully and answer the questions below.

Select Medication
Offer is NOT valid for California or Massachusetts residents.
Patients are responsible for the first $10 co-pay for a 30-day supply of GLEEVEC and Novartis will pay up to $10,630 per 30-day supply up to $30,000 per calendar year. Patient is responsible for any costs once the limit is reached in a calendar year.
This offer is available for patients with a prescription for KISQALI, a prescription for FEMARA (including generic letrozole), a prescription for both products, or a prescription for the KISQALI/FEMARA Co-Pack. Use of the offer for FEMARA (or generic letrozole) does not require a KISQALI prescription.
Offer is NOT valid for purchases of FEMARA only by California or Massachusetts residents.
Are you taking SANDOSTATIN for an approved use, consistent with the product’s prescribing information (see link above)?
Patient eligibility certification and enrollment
In order to proceed with enrollment, please complete the eligibility certification above.
The personal information we collect from you, including your co-pay card, payment card or rebate usage, may be used to contact you in connection with your participation in the Novartis Oncology Universal Co-pay Program, and as provided in our Privacy Policy.
Please enter patient information
*Required
At least 1 phone number is required*
Telephone Consumer Protection Act (TCPA) Consent (Optional)
Marketing Communications (Optional)

If you have an existing co-pay card and need to let us know about an insurance change, or if any personal information associated with the card has changed (such as your name or address), please call 1-877-577-7756.
Terms and Conditions:
The Novartis Oncology Universal Co-pay Program includes the co-pay card, payment card, or rebate with a combined annual limit of $15,000. Patient is responsible for any costs once the limit is reached in a calendar year.
  • This offer is only available to patients with private insurance. The program is not available for patients who: (i) are enrolled in Medicare, Medicaid, TRICARE, VA, DoD, or any other federal or state health care program; (ii) are not using insurance coverage at all; (iii) are enrolled in an insurance plan that reimburses for the entire cost of the drug; or (iv) where product is not covered by patient’s insurance.
  • The value of this program is exclusively for the benefit of enrolled patients and is intended to be credited toward patient out-of-pocket obligations, including applicable co-payments, coinsurance, and deductibles.
  • Proof of purchase may be required.
  • Patient may not seek reimbursement for the value received from this program from other parties, including any health insurance program or plan, flexible spending account, or health care savings account.
  • Patient is responsible for complying with any applicable limitations and requirements of his/her health plan related to the use of the program.
  • program is not valid where prohibited by law. Valid only in the United States and Puerto Rico. Offer is not valid for California or Massachusetts residents for certain medications.
  • This program is not health insurance. This program may not be combined with any third-party rebate, coupon, or offer.
  • Novartis reserves the right to rescind, revoke, or amend the program and discontinue support at any time without notice.
Patient Instructions: After enrollment in the program, present this card and your insurance card along with a valid prescription at any participating pharmacy or through mail order. Patients are responsible for up to the first $25 (specific offer varies by brand) and Novartis pays up to $15,000 per calendar year. If patient reaches the maximum annual cap per calendar year of $15,000, patient will be responsible for the difference. When you use this card, you are certifying that you understand and agree to comply with the program Terms and Conditions above. Direct patient questions to: 1-877-577-7756.
When you use this card, you are certifying that you understand and agree to comply with the program Terms and Conditions above.
Patient questions, please call 1-877-577-7756.

11/18 ONC-1196564