www.novocare.com
Open in
urlscan Pro
72.3.137.119
Public Scan
Submitted URL: http://email.mail.veeva.novonordisk.com/c/eJx8kU9z0zAQxT-NfKtHWvlfDj64dcy0cIBChnJiZGkTq9iS0R8Hvj2jEDI9sce3v923b_bl7oMYcW5JfU8AVmdVlOFREQ...
Effective URL: https://www.novocare.com/diabetes/products/rybelsus/savings-offer.html?utm_medium=email&utm_source=RTE&utm_campaign=succe...
Submission: On November 20 via manual from US — Scanned from DE
Effective URL: https://www.novocare.com/diabetes/products/rybelsus/savings-offer.html?utm_medium=email&utm_source=RTE&utm_campaign=succe...
Submission: On November 20 via manual from US — Scanned from DE
Form analysis 2 forms found in the DOM
Name: savings-card —
<form class="regform-body" novalidate="" name="savings-card" data-name="savings-card" data-redirect-error="/content/novocare/en/diabetes/products/rybelsus/savings-offer/result.html" data-data-binding="[]" data-endpoint=".pspCopayProgram.html"
data-actiononsuccess="REDIRECT" data-actionpath="/content/novocare/en/diabetes/products/rybelsus/savings-offer/result.html" data-successpage="/content/novocare/en/diabetes/products/rybelsus/savings-offer/result.html"
data-webserviceerror="Some error has occurred. Please try again." data-webservicefail="We're sorry, your account is currently unavailable. We're currently working to fix the issue. Please check back soon." data-organicactivitycode="100001557"
data-valuetocancelredirect="nni:medication/type2/MEDTYPE/OZEMPIC-NO" data-offline="TRUE"
data-idsvalues="enrolledRadio Yes, I am enrolled=,enrolledRadio No, I am not enrolled=,commercialinsu Yes=,commercialinsu No=,Next: About me=,firstname=,lastname=,email=,dob=,language=,address1=,city=,state=,zip=,Next: Confirm=,agreement I agree=,agreement I disagree=,phone-permission I agree=,phone-permission I disagree=,phone-number=,terms-condition=,Next: Get savings card=">
<fieldset style="border-style: none;">
<legend class="sr-only"></legend>
<div name="initial-properties"></div>
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="contentbox aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-right: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="genericText aem-GridColumn--phone--hide aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0">
<div id="textid96df9b4f-6e7e-43e7-b09c-65e4d8bf1efc" class="">
<p style="font-size: 12.8px; line-height: 16.0px; color: rgb(74,74,74); text-align: right;">*Indicates required field.</p>
</div>
</div>
<div
class="genericText aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--phone--none aem-GridColumn--default--hide aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--tablet--hide">
<div id="textide6adc13b-d313-4a21-8512-01e9cf7bc02c" class="">
<p style="font-size: 12.8px; line-height: 16.0px; color: rgb(74,74,74);">*Indicates required field.</p>
</div>
</div>
</div>
</div>
</section>
</div>
<div class="form-step experiencefragment aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="form-step" data-tagid="eligibility-savingsCard" data-name="1. Eligibility" data-wait-to-execute="0"
data-auto-submit-options="[ {"property": "showBanner", "operation": "equals", "value": "yes"}]" data-show-hide-action="true"
data-sections-name="header-section|header-text-section,flag1,none|flag2,none|flag3,none|flag4,rybelsus-flyer" style="">
<div class="xf-content-height">
<div class="aem-Grid aem-Grid--24 aem-Grid--default--24 ">
<div class="contentbox aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--24 aem-GridColumn--offset--default--0">
<section class="content-box ">
<div class="content-box-content container" style="padding-right: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="genericText aem-GridColumn--phone--hide aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0">
<div id="textid1f62b21d-9b05-4b02-93ea-f35ad4e7aa96" class="">
<p style="font-size: 35.0px; line-height: 24.0px;">Let's get started</p>
</div>
</div>
<div class="genericText aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--default--hide aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0 aem-GridColumn--tablet--hide">
<div id="textidf511c943-db3f-442f-a297-cbf3eabb1a39" class="">
<p style="font-size: 26.0px; line-height: 24.0px;">Let's get started</p>
</div>
</div>
<div class="radiogroup aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="radiogroup-component rdo-default default radiogroup-1700488230495 default-rbtn inp-comp" data-name="enrolledRadio" data-label="<p style="font-size: 16.0px; line-height: 24.0px;"><strong>Are you enrolled in any government, state, or federally funded medical or prescription benefit programs?</strong><br>
<em>(Examples include but are not limited to Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program.)</em></p>
" data-options="[ {"uuid": "-1482876715", "parentValue": "", "tagid": "registrationForm_enrolled_yes", "value": "true", "text": "Yes, I am enrolled", "accordionbody":"", "action": "show", "hiddenSection": "rybelsus-flyer,enrolled-msg-section|aboutme-section,none|insurance-choice-section,none|enrolled-commercial-section"} , {"uuid": "-1482876715", "parentValue": "", "tagid": "registrationForm_enrolled_no", "value": "false", "text": "No, I am not enrolled", "accordionbody":"", "action": "show", "hiddenSection": "aboutme-section,insurance-choice-section|enrolled-msg-section,none|enrolled-commercial-section,none|rybelsus-flyer"}]"
data-optionstyle="rdo-default" data-required="true" data-fieldrequiredmessage="Please make a selection." data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment" data-gaeventaction="Field Interaction - Radio Button"
data-gaeventlabel="registrationForm_enrolled_yes" data-gaeventvalue="true">
<div class="form-grouped"><label name="enrolledRadio" data-name="enrolledRadio" idvalidator="372392f3-3e6d-429f-bb28-73a769a3de13" data-value="" fieldform="true" class="control-label"><span>
<p style="font-size: 16.0px; line-height: 24.0px;"><strong>Are you enrolled in any government, state, or federally funded medical or prescription benefit programs?</strong><br>
<em>(Examples include but are not limited to Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program.)</em><span class="req">*</span>
</p>
</span></label>
<fieldset>
<legend></legend><label class="radio" for="registrationForm_enrolled_yes--1482876715"><input id="registrationForm_enrolled_yes--1482876715" name="enrolledRadio" type="radio" fieldform="true"
data-nameid="enrolledRadio Yes, I am enrolled" data-description="Are you enrolled in any government, state, or federally funded medical or prescription benefit programs?
(Examples include but are not limited to Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program.)" value="true" aria-label="Are you enrolled in any government, state, or federally funded medical or prescription benefit programs?
(Examples include but are not limited to Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program.)"><span class="pl-2 radio-label">Yes, I am enrolled</span><span class="radio-circle"><span
class="radio-checked"></span></span></label><label class="radio" for="registrationForm_enrolled_no--1482876715"><input id="registrationForm_enrolled_no--1482876715" name="enrolledRadio" type="radio"
fieldform="true" data-nameid="enrolledRadio No, I am not enrolled" data-description="Are you enrolled in any government, state, or federally funded medical or prescription benefit programs?
(Examples include but are not limited to Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program.)" value="false" aria-label="Are you enrolled in any government, state, or federally funded medical or prescription benefit programs?
(Examples include but are not limited to Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program.)"><span class="pl-2 radio-label">No, I am not enrolled</span><span class="radio-circle"><span
class="radio-checked"></span></span></label>
</fieldset>
</div>
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="enrolled-msg-section" data-control-state="0" data-open-options="[]">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="contentbox aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0">
<section class="content-box " style="margin: 0px 0 30px 0 !important; background-color: #ffffff;border: 2px solid #cccccc; ">
<div class="content-box-content container-fluid" style="padding-top: 20px; padding-bottom: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488230505>img {
padding-right: 30px;
}
.media-1700488230505>.media-body {}
.media-1700488230505>.media-body-content {}
@media (max-width: 991px) {
.media-1700488230505>img {
padding-bottom: 15px;
padding-left: 30px;
}
.media-1700488230505>.media-body {
padding: left;
: 30px;
;
}
.media-1700488230505>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488230505 m-normal-order flex-column flex-lg-row">
<img src="/content/dam/novonordisk/novocare/icons/i-Icon_74x74.png" class="m-center m-top left top ">
<div class="media-body text-center m-center m-top text-lg-left right bottom">
<p>We’re sorry, but you are not eligible to participate in this program because you currently participate in a government, state, or federally funded prescription benefit program.</p>
<p> </p>
<p><strong>However, you can still get support by signing up for text messages about RYBELSUS<sup>®</sup>.</strong></p>
</div>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="insurance-choice-section" data-control-state="0" data-open-options="[]">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="horizontalbar aem-GridColumn aem-GridColumn--default--12">
<div class="hr-cmp">
<hr class="hr--primary--color border-0" style=" height:2px; margin-top:-10px; margin-bottom:30px; background-color:#ffffff;">
</div>
</div>
<div class="radiogroup aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="radiogroup-component rdo-default default radiogroup-1700488230512 default-rbtn inp-comp" data-name="commercialinsu" data-label="<p style="font-size: 16.0px; line-height: 24.0px;"><strong>Do you have commercial (also known as private) insurance that covers your prescription? (Insurance provided through an employer)</strong></p>
" data-options="[ {"uuid": "-1722463383", "parentValue": "", "tagid": "insurance-choice_enrolled_yes", "value": "true", "text": "Yes", "accordionbody":"", "action": "show", "hiddenSection": "aboutme-section|enrolled-commercial-section,none|rybelsus-flyer"} , {"uuid": "-1722463383", "parentValue": "", "tagid": "insuranceChoice_enrolled_no", "value": "false", "text": "No", "accordionbody":"", "action": "show", "hiddenSection": "rybelsus-flyer,enrolled-commercial-section|aboutme-section,none|enrolled-msg-section"}]"
data-optionstyle="rdo-default" data-required="true" data-fieldrequiredmessage="Please make a selection." data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment"
data-gaeventaction="Field Interaction - Radio Button " data-gaeventlabel="insurance-choice_enrolled_yes" data-gaeventvalue="true">
<div class="form-grouped"><label name="commercialinsu" data-name="commercialinsu" idvalidator="3a41fe3d-4ede-410b-a032-d8ccf6a1651a" data-value="" fieldform="true" class="control-label"><span>
<p style="font-size: 16.0px; line-height: 24.0px;"><strong>Do you have commercial (also known as private) insurance that covers your prescription? (Insurance provided through an employer)</strong><span
class="req">*</span></p>
</span></label>
<fieldset>
<legend></legend><label class="radio" for="insurance-choice_enrolled_yes--1722463383"><input id="insurance-choice_enrolled_yes--1722463383" name="commercialinsu" type="radio" fieldform="true"
data-nameid="commercialinsu Yes" data-description="Do you have commercial (also known as private) insurance that covers your prescription? (Insurance provided through an employer)" value="true"
aria-label="Do you have commercial (also known as private) insurance that covers your prescription? (Insurance provided through an employer)"><span class="pl-2 radio-label">Yes</span><span
class="radio-circle"><span class="radio-checked"></span></span></label><label class="radio" for="insuranceChoice_enrolled_no--1722463383"><input id="insuranceChoice_enrolled_no--1722463383"
name="commercialinsu" type="radio" fieldform="true" data-nameid="commercialinsu No"
data-description="Do you have commercial (also known as private) insurance that covers your prescription? (Insurance provided through an employer)" value="false"
aria-label="Do you have commercial (also known as private) insurance that covers your prescription? (Insurance provided through an employer)"><span class="pl-2 radio-label">No</span><span
class="radio-circle"><span class="radio-checked"></span></span></label>
</fieldset>
</div>
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="enrolled-commercial-section" data-control-state="0" data-open-options="[]">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box " style="margin: 0px 0 30px 0 !important; background-color: #ffffff;border: 2px solid #cccccc; ">
<div class="content-box-content container-fluid" style="padding-top: 20px; padding-bottom: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488230524>img {
padding-right: 30px;
}
.media-1700488230524>.media-body {}
.media-1700488230524>.media-body-content {}
@media (max-width: 991px) {
.media-1700488230524>img {
padding-bottom: 15px;
padding-left: 30px;
}
.media-1700488230524>.media-body {
padding: left;
: 30px;
;
}
.media-1700488230524>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488230524 m-normal-order flex-column flex-lg-row">
<img src="/content/dam/novonordisk/novocare/icons/i-Icon_74x74.png" class="m-center m-top left top ">
<div class="media-body text-center m-center m-top text-lg-left right bottom">
<p>We’re sorry, but you must be enrolled in a commercial insurance plan to participate in this program.</p>
<p> </p>
<p><strong>However, you can still get support by signing up for text messages about RYBELSUS<sup>®</sup>.</strong></p>
</div>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="" data-name="aboutme-section" data-control-state="1" data-auto-open="true" data-open-options="[]" data-incremental-state-disable="true">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 ">
<div class="horizontalbar aem-GridColumn aem-GridColumn--default--12">
<div class="hr-cmp">
<hr class="hr--primary--color border-0" style=" height:2px; margin-top:-10px; margin-bottom:30px; background-color:#ffffff;">
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:10px;">
</div>
</div>
<div class="submit aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--default--none aem-GridColumn--tablet--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="media__body">
<a id="registrationForm_next_about-me-679865817" href="#" class="btn btn-form-submit btn btn-cvi-compliance " data-tagid="registrationForm_next_about-me" data-nameid="Next: About me" data-description="Next: About me" data-movetostep="1" data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment" data-gaeventaction="Form Continue CTA" data-gaeventlabel="Next: About me" data-gaeventvalue="false" data-web-service-error="Some error has occurred. Please try again." aria-label="Next: About me">
<p>Next: About me</p>
</a>
</div>
<p erroronsubmit="true" class="help-block small msg-error "></p>
</div>
</div>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
<div class="form-step experiencefragment aem-GridColumn aem-GridColumn--default--12">
<div class="form-step" data-tagid="savings-card-aboutMe" data-name="2. About me" data-wait-to-execute="0" data-auto-submit-options="[]" data-show-hide-action="true"
data-sections-name="header-text-section|header-section,flag2,none|flag1,none|flag3,none|flag4" style="display: none;">
<div class="xf-content-height">
<div class="aem-Grid aem-Grid--24 aem-Grid--default--24 ">
<div class="contentbox aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--24 aem-GridColumn--offset--default--0">
<section class="content-box ">
<div class="content-box-content container" style="padding-right: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="step-header aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--6 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div class="step-title">
<p style="font-size: 20.0px;line-height: 24.0px;"><strong>Tell us about yourself</strong></p>
</div>
<p class="step-description"></p>
</div>
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="operation" data-value="registerAccount" aria-hidden="true" role="none">
<input type="hidden" fieldform="true" name="password" data-value="C4CSDPassword@4567" aria-hidden="true" role="none">
</div>
<div class="textfield aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="textfield-component inp-comp" data-tagid="registrationForm_firstname" data-name="firstname" data-alias="patientFname" data-label="<p>First name</p>
" data-width="is-full" data-required="true" data-onlyletters="true" data-scpecial-characters="true" data-fieldrequiredmessage="Please enter your first name." data-fieldinvalidmessage="Please enter a valid first name."
data-fieldminerrormessage="Must be at least ${min} characters" data-fieldmaxerrormessage="Must be at most ${max} characters" data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment"
data-gaeventaction="Field Interaction - Text Box" data-gaeventlabel="registrationForm_firstname" data-gaeventvalue="true" data-gaeventprepopulated="false">
<div class="form-grouped"><label for="registrationForm_firstname" class="control-label"><span>
<p>First name<span class="req">*</span></p>
</span></label>
<div class="input-grouped is-full"><input id="registrationForm_firstname" name="firstname" data-name="firstname" idvalidator="b7150318-dda0-4e42-bb22-506a83581b3c" type="text" fieldform="true"
class="form-field-control field-text-base" aria-label="First name" data-value="" data-nameid="firstname" data-description="First name" autocomplete="off" value=""><span class="input-grouped-addon"></span></div>
<p class="help-block msg-waiting"><span class="rq-icon fa fa-spinner fa-spin"></span></p>
</div>
</div>
</div>
<div class="textfield aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="textfield-component inp-comp" data-tagid="registrationForm_lastname" data-name="lastname" data-label="<p>Last name</p>
" data-width="is-full" data-required="true" data-onlyletters="true" data-scpecial-characters="true" data-fieldrequiredmessage="Please enter your last name." data-fieldinvalidmessage="Please enter a valid last name."
data-fieldminerrormessage="Must be at least ${min} characters" data-fieldmaxerrormessage="Must be at most ${max} characters" data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment"
data-gaeventaction="Field Interaction - Text Box" data-gaeventlabel="registrationForm_lastname" data-gaeventvalue="true" data-gaeventprepopulated="false">
<div class="form-grouped"><label for="registrationForm_lastname" class="control-label"><span>
<p>Last name<span class="req">*</span></p>
</span></label>
<div class="input-grouped is-full"><input id="registrationForm_lastname" name="lastname" data-name="lastname" idvalidator="8ee342fe-5f7b-40aa-bf9b-a937801747a6" type="text" fieldform="true"
class="form-field-control field-text-base" aria-label="Last name" data-value="" data-nameid="lastname" data-description="Last name" autocomplete="off" value=""><span class="input-grouped-addon"></span></div>
<p class="help-block msg-waiting"><span class="rq-icon fa fa-spinner fa-spin"></span></p>
</div>
</div>
</div>
<div class="mailfield aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="mailfield-component inp-comp" data-tagid="registrationForm_email" data-name="email" data-alias="email" data-label="<p>Email address</p>
" data-width="is-full" data-required="true" data-novalidateemail="true" data-sectionwhenexist="signin-section|newuser-section,none|submit-section" data-sectionwhennotexist="newuser-section|signin-section,none|submit-section"
data-sectiondefault="submit-section|signin-section, none|newuser-section" data-fieldrequiredmessage="Please enter your email address." data-fieldinvalidmessage="Please enter a valid email address."
data-fieldexistsmessage="The email used is already in use." data-fieldminerrormessage="Must be at least ${min} characters" data-fieldmaxerrormessage="Must be at most ${max} characters"
data-fieldrequestwaitmessage="Checking for an existing<br>SaxendaCare<sup>®</sup> account" data-emailexistsendpoint=".pspCopayProgram.html" data-emailexistsoperation="emailexists"
data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment" data-gaeventaction="Field Interaction - Text Box" data-gaeventlabel="registrationForm_email" data-gaeventvalue="true">
<div class="form-grouped"><label for="registrationForm_email" class="control-label"><span>
<p>Email address<span class="req">*</span></p>
</span></label>
<div class="input-grouped with-notify is-full"><input id="registrationForm_email" name="email" data-name="email" idvalidator="f01f7a63-3d3e-43f6-9c67-f65c5edda3c8" type="email" fieldform="true"
class="form-field-control field-text-base" aria-label="Email address" data-value="" data-nameid="email" data-description="Email address" autocomplete="off" value=""><span class="input-grouped-addon"></span></div>
<p class="help-block msg-waiting"><span class="rq-icon fa fa-spinner fa-spin"></span><span class="rq-msj"><span>Checking for an existing<br>SaxendaCare<sup>®</sup> account</span></span></p>
</div>
</div>
</div>
<div
class="datefield aem-GridColumn--offset--tablet--0 aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--6 aem-GridColumn--tablet--none aem-GridColumn aem-GridColumn--tablet--7 aem-GridColumn--default--5 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div class="datefield-component inp-comp" data-tagid="dob-event" data-name="dob" data-alias="patient-dob" data-label="<p>Date of birth</p>
" data-width="is-full" data-required="true" data-legalagerequired="true" data-fieldrequiredmessage="Please enter your date of birth." data-fieldlegalagemessage="You must be ${legalage} or older to sign up"
data-fieldinvalidmessage="Please enter a valid date of birth." data-legalage="18" data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment" data-gaeventaction="Field Interaction - Text Box"
data-gaeventlabel="dob-event" data-gaeventvalue="true">
<div class="form-grouped"><label for="dob-event" class="control-label"><span>
<p>Date of birth<span class="req">*</span></p>
</span></label>
<div class="input-grouped is-full"><input id="dob-event" name="dob" data-name="dob" idvalidator="fc09d537-790a-4a1e-b4f0-972282a26ff5" type="tel" fieldform="true" class="form-field-control field-text-base" placeholder=""
aria-label="Date of birth" data-value="" data-nameid="dob" data-description="Date of birth" autocomplete="off" value="" im-insert="true"><span class="input-grouped-addon"></span></div>
<p class="help-block msg-waiting"><span class="rq-icon fa fa-spinner fa-spin"></span></p>
</div>
</div>
</div>
<div class="radiogroup aem-GridColumn aem-GridColumn--default--12">
<div class="radiogroup-component rdo-default radiogroup-1700488230561 default-rbtn inp-comp" data-name="languagePreferences" data-alias="language" data-label="<p>Language preference</p>
" data-options="[ {"uuid": "311126107", "parentValue": "", "tagid": "en", "value": "en", "text": "English", "accordionbody":"", "action": "hide", "hiddenSection": "spanish-section-properties|english-section-properties"} , {"uuid": "311126107", "parentValue": "", "tagid": "es", "value": "es", "text": "Spanish", "accordionbody":"", "action": "show", "hiddenSection": "spanish-section-properties|english-section-properties"}]"
data-optionstyle="rdo-default" data-required="true" data-fieldrequiredmessage="Please make a selection." data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment" data-gaeventaction="Field Interaction - Radio Button "
data-gaeventlabel="registrationForm_spanishpreference" data-gaeventvalue="true">
<div class="form-grouped"><label name="languagePreferences" data-name="languagePreferences" idvalidator="81e672c7-73bc-4a2f-ad5c-bdc4d3ab17b2" data-value="" fieldform="true" class="control-label"><span>
<p>Language preference<span class="req">*</span></p>
</span></label>
<fieldset>
<legend></legend><label class="radio" for="en-311126107"><input id="en-311126107" name="languagePreferences" type="radio" fieldform="true" data-nameid="languagePreferences English" data-description="Language preference"
value="en" aria-label="Language preference"><span class="pl-2 radio-label">English</span><span class="radio-circle"><span class="radio-checked"></span></span></label><label class="radio" for="es-311126107"><input
id="es-311126107" name="languagePreferences" type="radio" fieldform="true" data-nameid="languagePreferences Spanish" data-description="Language preference" value="es" aria-label="Language preference"><span
class="pl-2 radio-label">Spanish</span><span class="radio-circle"><span class="radio-checked"></span></span></label>
</fieldset>
</div>
</div>
</div>
<div class="zipfield aem-GridColumn--phone--none aem-GridColumn--phone--6 aem-GridColumn aem-GridColumn--default--newline aem-GridColumn--default--5 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div class="zipfield-component inp-comp" data-tagid="zip" data-name="zip" data-label="<p>ZIP code</p>
" data-width="is-full" data-required="true" data-max="5" data-min="5" data-fieldrequiredmessage="Please enter your ZIP code." data-fieldinvalidmessage="Please enter a valid ZIP code." data-fieldminerrormessage="Must be at least ${min} characters"
data-fieldmaxerrormessage="Must be at most ${max} characters" data-gaeventvalue="false" data-zipcodevalidationendpoint=".wegovyZipCodeCheck.html">
<div class="form-grouped"><label for="zip" class="control-label"><span>
<p>ZIP code<span class="req">*</span></p>
</span></label>
<div class="input-grouped is-full"><input id="zip" name="zip" data-name="zip" idvalidator="626daaf1-475d-43d9-ae17-faaa7dd625bf" type="tel" fieldform="true" maxlength="5" class="form-field-control field-text-base"
aria-label="ZIP code" data-value="" data-nameid="zip" data-description="ZIP code" autocomplete="off" value=""><span class="input-grouped-addon"></span></div>
<p class="help-block msg-waiting"><span class="rq-icon fa fa-spinner fa-spin"></span></p>
</div>
</div>
</div>
<div class="horizontalbar aem-GridColumn aem-GridColumn--default--12">
<div class="hr-cmp">
<hr class="hr--primary--color border-0" style=" height:2px; margin-top:-10px; margin-bottom:30px; background-color:#ffffff;">
</div>
</div>
<div class="submit aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--newline aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div class="media__body">
<a id="nextButtonDefault-943150373" href="#" class="btn btn-form-submit btn btn-cvi-compliance " data-tagid="nextButtonDefault" data-nameid="Next: Support" data-description="Next: Support" data-movetostep="1" data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment" data-gaeventaction="Form Continue CTA" data-gaeventlabel="Next: Text support" data-gaeventvalue="false" data-web-service-error="Some error has occurred. Please try again." aria-label="Next: Support">
<p style="text-align: center;">Next: Support</p>
</a>
</div>
<p erroronsubmit="true" class="help-block small msg-error "></p>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:50px;">
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="spanish-section-properties" data-control-state="0" data-open-options="[]">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="organicactivitycode" data-value="100001630" aria-hidden="true" role="none">
</div>
</div>
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="english-section-properties" data-control-state="0" data-open-options="[]">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="organicactivitycode" data-value="100001557" aria-hidden="true" role="none">
</div>
</div>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
<div class="form-step experiencefragment aem-GridColumn aem-GridColumn--default--12">
<div class="form-step" data-tagid="savings-card-textOptions" data-name="3. Support" data-wait-to-execute="0" data-auto-submit-options="[]" data-show-hide-action="true"
data-sections-name="header-text-section|header-section,flag3,none|flag1,none|flag2,none|flag4" style="display: none;">
<div class="xf-content-height">
<div class="aem-Grid aem-Grid--24 aem-Grid--default--24 ">
<div class="contentbox aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--24 aem-GridColumn--offset--default--0">
<section class="content-box ">
<div class="content-box-content container">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="responsivegrid aem-GridColumn aem-GridColumn--default--12">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="pick_DHC" aria-hidden="true" role="none">
<input type="hidden" fieldform="true" name="sign-up-for-text-messages" aria-hidden="true" role="none">
</div>
<div
class="simplepanel parbase aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--phone--hide aem-GridColumn--default--hide aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--tablet--hide">
<!--[if lte IE 8]>
<![endif]-->
<style>
.custom-section-271c8c87cbed48dfa4a373193e8842af {}
</style>
<div class="simple-panel-container empty section-simple-panel-component 0 custom-section-271c8c87cbed48dfa4a373193e8842af "
style=" background-color: #E2F0FA; margin-top: 0px; padding-top: 0px; padding-right: 0px; padding-left: 0px; " title="">
<!--TODO: check if this is necessary otherwise remove -->
<!-- Added hidden images to display meta data for PDF generator -->
<!-- Desktop Image -->
<div class="responsivegrid">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="genericText aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div id="textid2a336d9f-3e36-4c87-8544-90308f910824" class="">
<p style="padding: 10.0px; background-color: rgb(160,205,239); text-align: center; font-size: 22.0px; line-height: 32.0px;"><strong>Here is what you will get with RYBELSUS<sup>®</sup> Connect:</strong></p>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:10px;">
</div>
</div>
<div class="simplepanel parbase aem-GridColumn aem-GridColumn--default--12">
<!--[if lte IE 8]>
<![endif]-->
<style>
.custom-section-59f3b04f30564bd1ac484d25df9132c7 {}
</style>
<div class="simple-panel-container empty section-simple-panel-component custom-section-59f3b04f30564bd1ac484d25df9132c7 " style=" " title="">
<!--TODO: check if this is necessary otherwise remove -->
<!-- Added hidden images to display meta data for PDF generator -->
<!-- Desktop Image -->
<div class="responsivegrid">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-right: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488230695>img {
width: 96px;
}
.media-1700488230695>.media-body {}
.media-1700488230695>.media-body-content {}
@media (max-width: 991px) {
.media-1700488230695>img {}
.media-1700488230695>.media-body {}
.media-1700488230695>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488230695 m-normal-order flex-column flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_reminders.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid2582b568-d35b-44c2-b37d-45fd7517e06f" class="">
<p style="text-align: center; font-size: 18.0px; line-height: 24.0px; color: rgb(23,28,143);"><strong>Medicine<br> reminders</strong></p>
</div>
</div>
</div>
</div>
</section>
</div>
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488230711>img {
width: 96px;
}
.media-1700488230711>.media-body {}
.media-1700488230711>.media-body-content {}
@media (max-width: 991px) {
.media-1700488230711>img {}
.media-1700488230711>.media-body {}
.media-1700488230711>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488230711 m-normal-order flex-column flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_info.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid817ccd2c-349b-4cec-ac53-67f44de01a0d" class="">
<p style="text-align: center; font-size: 18.0px; line-height: 24.0px; color: rgb(23,28,143);"><strong>Helpful<br> information</strong></p>
</div>
</div>
</div>
</div>
</section>
</div>
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488230726>img {
width: 96px;
}
.media-1700488230726>.media-body {}
.media-1700488230726>.media-body-content {}
@media (max-width: 991px) {
.media-1700488230726>img {}
.media-1700488230726>.media-body {}
.media-1700488230726>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488230726 m-normal-order flex-column flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_motivation.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid690069ad-9448-4b4e-8760-051e368b970e" class="">
<p style="text-align: center; font-size: 18.0px; line-height: 24.0px; color: rgb(23,28,143);"><strong>Motivational<br> messages</strong></p>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:20px;">
</div>
</div>
<div class="step-header aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="step-title">
<h6><strong class="h6"><strong>Get personalized support</strong></strong></h6>
<p><strong class="h6"> </strong></p>
</div>
<p class="step-description"></p>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textidc0b058df-7172-47c0-915f-129af6ad59c0" class="">
<p style="font-size: 16.0px; line-height: 24.0px;">To help tailor your support experience, we need to know some basic information about how your type 2 diabetes is being treated. Please know that you do not need
to sign up for support in order to get your savings offer.</p>
</div>
</div>
<div class="radiogroup aem-GridColumn aem-GridColumn--default--newline aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="radiogroup-component rdo-default default radiogroup-1700488230737 default-rbtn inp-comp" data-name="prescribed" data-label="<p style="font-size: 16.0px;line-height: 24.0px;"><strong>Are you on RYBELSUS<sup>®</sup>?</strong></p>
" data-options="[ {"uuid": "-1086702279", "parentValue": "", "tagid": "brand-yes", "value": "yes", "text": "Yes", "accordionbody":"", "action": "show", "hiddenSection": "taking-rybelsus,taking-rybelsus-medication,taking-rybelsus-wrapper,no-rybelsus-section|not-taking-rybelsus"} , {"uuid": "-1086702279", "parentValue": "", "tagid": "brand-no", "value": "no", "text": "No", "accordionbody":"", "action": "hide", "hiddenSection": "taking-rybelsus,taking-rybelsus-medication,,taking-rybelsus-wrapper,no-rybelsus-section|not-taking-rybelsus"}]"
data-optionstyle="rdo-default" data-required="true" data-fieldrequiredmessage="Please make a selection." data-gaeventvalue="false">
<div class="form-grouped"><label name="prescribed" data-name="prescribed" idvalidator="b92a5060-1fc3-4947-9ce5-1b9febe75138" data-value="" fieldform="true" class="control-label"><span>
<p style="font-size: 16.0px;line-height: 24.0px;"><strong>Are you on RYBELSUS<sup>®</sup>?</strong><span class="req">*</span></p>
</span></label>
<fieldset>
<legend></legend><label class="radio" for="brand-yes--1086702279"><input id="brand-yes--1086702279" name="prescribed" type="radio" fieldform="true" data-nameid="prescribed Yes"
data-description="Are you on RYBELSUS®?" value="yes" aria-label="Are you on RYBELSUS®?"><span class="pl-2 radio-label">Yes</span><span class="radio-circle"><span class="radio-checked"></span></span></label><label
class="radio" for="brand-no--1086702279"><input id="brand-no--1086702279" name="prescribed" type="radio" fieldform="true" data-nameid="prescribed No" data-description="Are you on RYBELSUS®?" value="no"
aria-label="Are you on RYBELSUS®?"><span class="pl-2 radio-label">No</span><span class="radio-circle"><span class="radio-checked"></span></span></label>
</fieldset>
</div>
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="not-taking-rybelsus" data-control-state="0" data-state-value="1" data-open-options="[]">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:30px;">
</div>
</div>
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="medication" data-value="nni:medication/type2/MEDTYPE/RYBELSUS-NO" aria-hidden="true" role="none">
</div>
<div class="horizontalbar aem-GridColumn aem-GridColumn--default--12">
<div class="hr-cmp">
<hr class="hr--secondary--color border-0" style=" height:1px; background-color:#939AA7;">
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:20px;">
</div>
</div>
<div class="step-header aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="step-title">
<p style="font-size: 20.0px;line-height: 24.0px;"><strong>You’re eligible for FREE text support! </strong></p>
</div>
<p class="step-description"></p>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textidf5f1f57c-709c-473e-b1db-43e80dbfcd16" class="">
<p style="font-size: 16.0px; line-height: 24.0px;"><strong>RYBELSUS<sup>®</sup> Connect is a FREE text program designed to help you start and stay on RYBELSUS<sup>®</sup>.<sup>a</sup></strong></p>
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid9650489c-5c50-4af1-9ae0-b1b7f433ca46" class="">
<p style="line-height: 16.0px; color: rgb(74,74,74);"><small><sup>a</sup>Message and data rates may apply. Check with your mobile service provider. Message frequency will be based on your selections. Text HELP to
21848 for help. Text STOP to 21848 to quit. See Terms and Conditions of Use at <a href="https://www.rybelsus.com/terms-and-conditions.html" target="_self">RYBELSUS.com</a>.</small></p>
<p><small> </small></p>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:20px;">
</div>
</div>
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box " style="margin: 0px 0 0 0 !important; ">
<div class="content-box-content container-fluid" style="padding-top: 20px; padding-right: 0px; padding-bottom: 20px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box " style="background-color: #A0CDEF;">
<div class="content-box-content container-fluid" style="padding-top: 4px; padding-right: 0px; padding-bottom: 4px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="genericText aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div id="textide2e48b6e-435a-4e97-9251-0af4f0f6bd91" class="">
<p style="text-align: center; font-size: 22.0px; line-height: 32.0px; margin: 0;">Here is what you will get with RYBELSUS<sup>®</sup> Connect:</p>
</div>
</div>
</div>
</div>
</section>
</div>
<div class="simplepanel parbase aem-GridColumn--phone--hide aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0">
<!--[if lte IE 8]>
<![endif]-->
<style>
.custom-section-70837129cdee44a8add7450adfd01298 {}
</style>
<div class="simple-panel-container empty section-simple-panel-component custom-section-70837129cdee44a8add7450adfd01298 "
style=" background-color: #E2F0FA; margin-top: 0px; padding-right: 40px; padding-left: 40px; " title="">
<!--TODO: check if this is necessary otherwise remove -->
<!-- Added hidden images to display meta data for PDF generator -->
<!-- Desktop Image -->
<div class="responsivegrid">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box ">
<div class="content-box-content container-fluid">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--6 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488230834>img {
width: 96px;
}
.media-1700488230834>.media-body {}
.media-1700488230834>.media-body-content {}
@media (max-width: 991px) {
.media-1700488230834>img {}
.media-1700488230834>.media-body {}
.media-1700488230834>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488230834 m-normal-order flex-row flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_reminders.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid3f13c671-1377-4309-a614-b048da838326" class="">
<p style="text-align: center;"><span class="h7" style="color: #001965;"><strong>Medicine<br> reminders</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--6 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488230848>img {
width: 96px;
}
.media-1700488230848>.media-body {}
.media-1700488230848>.media-body-content {}
@media (max-width: 991px) {
.media-1700488230848>img {}
.media-1700488230848>.media-body {}
.media-1700488230848>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488230848 m-normal-order flex-row flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_info.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textidb5b907a7-d416-465b-a90a-463829330455" class="">
<p style="text-align: center;"><span class="h7" style="color: rgb(0,25,101);"><strong>Helpful<br> information</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--6 aem-GridColumn--offset--phone--3 aem-GridColumn aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488230863>img {
width: 96px;
}
.media-1700488230863>.media-body {}
.media-1700488230863>.media-body-content {}
@media (max-width: 991px) {
.media-1700488230863>img {}
.media-1700488230863>.media-body {}
.media-1700488230863>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488230863 m-normal-order flex-row flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_motivation.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textidb0725498-c6b7-4900-b89d-fd392ad4fb6d" class="">
<p style="text-align: center;"><span class="h7" style="color: rgb(0,25,101);"><strong>Motivational<br> messages</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
<div
class="simplepanel parbase aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--default--hide aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0 aem-GridColumn--tablet--hide">
<!--[if lte IE 8]>
<![endif]-->
<style>
.custom-section-98918cefe52b46849b5470dc309c40b8 {}
</style>
<div class="simple-panel-container empty section-simple-panel-component 0 custom-section-98918cefe52b46849b5470dc309c40b8 "
style=" background-color: #E2F0FA; margin-top: 0px; padding-top: 0px; padding-right: 0px; padding-left: 0px; " title="">
<!--TODO: check if this is necessary otherwise remove -->
<!-- Added hidden images to display meta data for PDF generator -->
<!-- Desktop Image -->
<div class="responsivegrid">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="simplepanel parbase aem-GridColumn aem-GridColumn--default--12">
<!--[if lte IE 8]>
<![endif]-->
<style>
.custom-section-b413afa85fdd4d2798bb591e4150533e {}
</style>
<div class="simple-panel-container empty section-simple-panel-component custom-section-b413afa85fdd4d2798bb591e4150533e " style=" " title="">
<!--TODO: check if this is necessary otherwise remove -->
<!-- Added hidden images to display meta data for PDF generator -->
<!-- Desktop Image -->
<div class="responsivegrid">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-right: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488230911>img {
width: 96px;
}
.media-1700488230911>.media-body {}
.media-1700488230911>.media-body-content {}
@media (max-width: 991px) {
.media-1700488230911>img {}
.media-1700488230911>.media-body {}
.media-1700488230911>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488230911 m-normal-order flex-column flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_reminders.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid7cac1c8d-a026-45e3-8e3d-54edb848fa9a" class="">
<p style="text-align: center;"><span class="h7" style="color: rgb(0,25,101);"><strong>Medicine reminders</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488230929>img {
width: 96px;
}
.media-1700488230929>.media-body {}
.media-1700488230929>.media-body-content {}
@media (max-width: 991px) {
.media-1700488230929>img {}
.media-1700488230929>.media-body {}
.media-1700488230929>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488230929 m-normal-order flex-column flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_info.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid5f71370f-aa36-42cb-ad43-455c1c785aee" class="">
<p style="text-align: center;"><span class="h7" style="color: rgb(0,25,101);"><strong>Helpful information</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488230945>img {
width: 96px;
}
.media-1700488230945>.media-body {}
.media-1700488230945>.media-body-content {}
@media (max-width: 991px) {
.media-1700488230945>img {}
.media-1700488230945>.media-body {}
.media-1700488230945>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488230945 m-normal-order flex-column flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_motivation.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textidf7412f1b-6930-42dd-a61b-b2d5009e0adf" class="">
<p style="text-align: center;"><span class="h7" style="color: rgb(0,25,101);"><strong>Motivational messages</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</section>
</div>
<div class="verticalspacing parbase aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div style="height:30px;">
</div>
</div>
<div class="radiogroup aem-GridColumn aem-GridColumn--default--12">
<div class="radiogroup-component rdo-default default radiogroup-1700488230954 default-rbtn inp-comp" data-name="sign-up-for-text-messages" data-label="<p style="font-size: 16.0px; line-height: 24.0px;"><strong>Would you like to sign up for text messages?</strong></p>
" data-options="[ {"uuid": "-1416933294", "parentValue": "", "tagid": "ryb-en-sign-up-for-text-messages-yes", "value": "yes", "text": "Yes", "accordionbody":"", "action": "show", "hiddenSection": "signup-section|no-signup"} , {"uuid": "-1416933294", "parentValue": "", "tagid": "ryb-en-sign-up-for-text-messages-no", "value": "no", "text": "Not right now", "accordionbody":"", "action": "hide", "hiddenSection": "signup-section|no-signup"}]"
data-optionstyle="rdo-default" data-required="true" data-fieldrequiredmessage="Please make a selection." data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment"
data-gaeventaction="Field Interaction - Radio Button " data-gaeventlabel="sign-up-for-text-messages" data-gaeventvalue="true">
<div class="form-grouped"><label name="sign-up-for-text-messages" data-name="sign-up-for-text-messages" idvalidator="b3198589-6ba3-417d-ae6d-486218cc0975" data-value="" fieldform="true" class="control-label"><span>
<p style="font-size: 16.0px; line-height: 24.0px;"><strong>Would you like to sign up for text messages?</strong><span class="req">*</span></p>
</span></label>
<fieldset>
<legend></legend><label class="radio" for="ryb-en-sign-up-for-text-messages-yes--1416933294"><input id="ryb-en-sign-up-for-text-messages-yes--1416933294" name="sign-up-for-text-messages" type="radio"
fieldform="true" data-nameid="sign-up-for-text-messages Yes" data-description="Would you like to sign up for text messages?" value="yes" aria-label="Would you like to sign up for text messages?"><span
class="pl-2 radio-label">Yes</span><span class="radio-circle"><span class="radio-checked"></span></span></label><label class="radio" for="ryb-en-sign-up-for-text-messages-no--1416933294"><input
id="ryb-en-sign-up-for-text-messages-no--1416933294" name="sign-up-for-text-messages" type="radio" fieldform="true" data-nameid="sign-up-for-text-messages Not right now"
data-description="Would you like to sign up for text messages?" value="no" aria-label="Would you like to sign up for text messages?"><span class="pl-2 radio-label">Not right now</span><span
class="radio-circle"><span class="radio-checked"></span></span></label>
</fieldset>
</div>
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="no-signup" data-control-state="0" data-state-value="1" data-open-options="[]">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid28f54919-92a2-4579-be01-5835840dba94" class="">
<p>Select “Confirm” below to continue on to get your savings offer. You may <strong>text READY to 21848</strong> anytime to start text support for RYBELSUS<sup>®</sup>.</p>
</div>
</div>
</div>
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="signup-section" data-control-state="0" data-state-value="1" data-open-options="[]">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="phonefield aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn--tablet--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0">
<div class="phonefield-component inp-comp" data-tagid="phoneNumber" data-name="mobile-number" data-label="<p><strong>Mobile phone number</strong></p>
" data-width="is-full" data-required="true" data-fieldrequiredmessage="Please enter a mobile phone number." data-fieldinvalidmessage="Please enter a valid mobile phone number." data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment"
data-gaeventaction="Field Interaction - Text Box" data-gaeventlabel="phoneNumber" data-gaeventvalue="true">
<div class="form-grouped"><label for="phoneNumber" class="control-label"><span>
<p><strong>Mobile phone number</strong><span class="req">*</span></p>
</span></label>
<div class="input-grouped is-full"><input id="phoneNumber" name="mobile-number" data-name="mobile-number" idvalidator="7a5301ab-a597-428b-a821-7796cb32bf4d" type="tel" fieldform="true"
class="form-field-control field-text-base" placeholder="" aria-label="Mobile phone number" data-value="" data-nameid="mobile-number" data-description="Mobile phone number" autocomplete="off" value=""
im-insert="true"><span class="input-grouped-addon"></span></div>
<p class="help-block msg-waiting"><span class="rq-icon fa fa-spinner fa-spin"></span></p>
</div>
</div>
</div>
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box " style="border: 1px solid #ffffff; ">
<div class="content-box-content container-fluid" style="padding-right: 0px; padding-bottom: 20px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="checkboxfield aem-GridColumn aem-GridColumn--default--12">
<div class="checkboxfield-component inp-comp" data-tagid="rybelsus-sc-sms-opt" data-name="phone-permission" data-checkboxtext="<p>I would like Novo Nordisk to contact me via telephone and text message at the telephone number(s) I provided above regarding Novo Nordisk’s products, goods, or services. I understand these calls or texts may be generated using an automated technology and I do not have to consent to receive communications via telephone or text message before purchasing goods or receiving other services from Novo Nordisk.</p>
" data-hiddensection="hipaa-release" data-askteriskposition="nex-to-label" data-width="is-full" data-chkboxstyle="chkbx-simple" data-mandatory="true" data-mandatoryerror="This is a required field"
data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment" data-gaeventaction="Field Interaction - Check Box" data-gaeventlabel="confirm_reference" data-gaeventvalue="true">
<div class="form-grouped checkbox-inner-container chkbx-simple">
<div class="checkbox chkbx-simple is-full"><label for="rybelsus-sc-sms-opt" class="chk-label"><input id="rybelsus-sc-sms-opt" name="phone-permission" data-name="phone-permission"
idvalidator="1bd0c0da-148d-40bd-8bbf-18804d37c123" type="checkbox" fieldform="true" class="" data-value="false" data-nameid="phone-permission"
data-description="I would like Novo Nordisk to contact me via telephone and text message at the telephone number(s) I provided above regarding Novo Nordisk’s products, goods, or services. I understand these calls or texts may be generated using an automated technology and I do not have to consent to receive communications via telephone or text message before purchasing goods or receiving other services from Novo Nordisk."
autocomplete="off" value="true"
aria-label="I would like Novo Nordisk to contact me via telephone and text message at the telephone number(s) I provided above regarding Novo Nordisk’s products, goods, or services. I understand these calls or texts may be generated using an automated technology and I do not have to consent to receive communications via telephone or text message before purchasing goods or receiving other services from Novo Nordisk."><span
class="pseudo-style"></span><span class="pl-2">
<p>I would like Novo Nordisk to contact me via telephone and text message at the telephone number(s) I provided above regarding Novo Nordisk’s products, goods, or services. I understand these
calls or texts may be generated using an automated technology and I do not have to consent to receive communications via telephone or text message before purchasing goods or receiving other
services from Novo Nordisk.<span class="req is-desktop-only">*</span></p>
</span></label></div>
</div>
</div>
</div>
</div>
</div>
</section>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textide94d48f9-1131-4bc0-b44e-160e429a0fe1" class="">
<p>Your personal health data may be shared by your pharmacy with Novo Nordisk and its partners. Once shared, you understand HIPAA may no longer protect your data. <strong>You do not need to answer “I agree”
to get the Savings Offer.</strong></p>
<p>Please review the <u><a href="https://www.rybelsus.com/content/dam/diabetes-patient/rybelsus/english/pdf/r-hipaa-waiver.pdf" target="Target">full waiver</a></u>.</p>
</div>
</div>
<div class="radiogroup aem-GridColumn aem-GridColumn--default--12">
<div class="radiogroup-component rdo-default default radiogroup-1700488230977 default-rbtn inp-comp" data-name="hipaaConsent" data-label="<p style="font-size: 16.0px; line-height: 24.0px;"><strong>Do you understand and agree to this data share?</strong></p>
" data-options="[ {"uuid": "524880123", "parentValue": "", "tagid": "agree-to-data-share-yes", "value": "yes", "text": "I agree", "accordionbody":"", "action": "show", "hiddenSection": "signup-section|no-signup"} , {"uuid": "524880123", "parentValue": "", "tagid": "agree-to-data-share-no", "value": "no", "text": "I disagree", "accordionbody":"", "action": "hide", "hiddenSection": "signup-section|no-signup"}]"
data-optionstyle="rdo-default" data-required="true" data-fieldrequiredmessage="Please make a selection." data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment"
data-gaeventaction="Field Interaction - Radio Button " data-gaeventlabel="sign-up-for-text-messages" data-gaeventvalue="true">
<div class="form-grouped"><label name="hipaaConsent" data-name="hipaaConsent" idvalidator="e244a3f0-13df-4530-aaba-f28341965ef6" data-value="" fieldform="true" class="control-label"><span>
<p style="font-size: 16.0px; line-height: 24.0px;"><strong>Do you understand and agree to this data share?</strong><span class="req">*</span></p>
</span></label>
<fieldset>
<legend></legend><label class="radio" for="agree-to-data-share-yes-524880123"><input id="agree-to-data-share-yes-524880123" name="hipaaConsent" type="radio" fieldform="true"
data-nameid="hipaaConsent I agree" data-description="Do you understand and agree to this data share?" value="yes" aria-label="Do you understand and agree to this data share?"><span
class="pl-2 radio-label">I agree</span><span class="radio-circle"><span class="radio-checked"></span></span></label><label class="radio" for="agree-to-data-share-no-524880123"><input
id="agree-to-data-share-no-524880123" name="hipaaConsent" type="radio" fieldform="true" data-nameid="hipaaConsent I disagree" data-description="Do you understand and agree to this data share?"
value="no" aria-label="Do you understand and agree to this data share?"><span class="pl-2 radio-label">I disagree</span><span class="radio-circle"><span class="radio-checked"></span></span></label>
</fieldset>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:40px;">
</div>
</div>
<div class="submit aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--newline aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<div class="media__body">
<a id="nextButtonConfirm-167531782" href="#" class="btn btn-form-submit btn btn-cvi-compliance " data-tagid="nextButtonConfirm" data-nameid="Next: Confirm" data-description="Next: Confirm" data-movetostep="1" data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment" data-gaeventaction="Form Continue CTA" data-gaeventlabel="Next: Confirm" data-gaeventvalue="false" data-web-service-error="Some error has occurred. Please try again." aria-label="Next: Confirm">
<p style="text-align: center;">Next: Confirm</p>
</a>
</div>
<p erroronsubmit="true" class="help-block small msg-error "></p>
</div>
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:20px;">
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="taking-rybelsus-medication" data-control-state="0" data-state-value="1" data-open-options="[]" data-incremental-state-disable="true">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="medication" data-value="nni:medication/type2/MEDTYPE/RYBELSUS" aria-hidden="true" role="none">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
<div class="form-step experiencefragment aem-GridColumn aem-GridColumn--default--12">
<div class="form-step" data-tagid="savings-card-confirmation" data-name="4. Confirmation" data-wait-to-execute="0" data-auto-submit-options="[]" data-show-hide-action="true" data-sections-name="flag4|flag1,none|flag2,none|flag3"
style="display: none;">
<div class="xf-content-height">
<div class="aem-Grid aem-Grid--24 aem-Grid--default--24 ">
<div class="contentbox aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--24 aem-GridColumn--offset--default--0">
<section class="content-box ">
<div class="content-box-content container" style="padding-right: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="step-header aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="step-title">
<p style="font-size: 20.0px;line-height: 24.0px;"><strong>Confirmation</strong></p>
</div>
<p class="step-description"></p>
</div>
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="brand" data-value="rybelsus" aria-hidden="true" role="none">
<input type="hidden" fieldform="true" name="campaign" aria-hidden="true" role="none">
<input type="hidden" fieldform="true" name="brandGroupId" data-value="EC20014001" aria-hidden="true" role="none">
<input type="hidden" fieldform="true" name="parentAttestation" data-value="false" aria-hidden="true" role="none">
<input type="hidden" fieldform="true" name="checkParent" data-value="false" aria-hidden="true" role="none">
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="no-rybelsus-section" data-control-state="0" data-state-value="1" data-open-options="[]" data-incremental-state-disable="true">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="pick_DHC" aria-hidden="true" role="none">
<input type="hidden" fieldform="true" name="sign-up-for-text-messages" aria-hidden="true" role="none">
<input type="hidden" fieldform="true" name="mobile-number" aria-hidden="true" role="none">
<input type="hidden" fieldform="true" name="phProgramConsent" aria-hidden="true" role="none">
<input type="hidden" fieldform="true" name="phone-permission" aria-hidden="true" role="none">
<input type="hidden" fieldform="true" name="phone-number" aria-hidden="true" role="none">
</div>
</div>
</div>
</div>
<div class="genericText aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div id="textid6abf47c9-b710-404d-85fb-509eef3f3d43" class="">
<p style="font-size: 16.0px; line-height: 24.0px;"><em>Registration is not complete until you indicate if you agree to each of the following statements</em></p>
</div>
</div>
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box " style="border: 1px solid #ffffff; ">
<div class="content-box-content container-fluid" style="padding-top: 20px; padding-right: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="htmlsource parbase aem-GridColumn aem-GridColumn--default--12">
<div class="htmlsourcetracking empty htmlsource-1700488231017">
<!-- OneTrust Privacy Notice start -->
<!-- Container in which the privacy notice will be rendered -->
<div id="otnotice-6111a539-acd2-44c8-8dbe-ab35ca6ce01c" class="otnotice">
<div class="otnotice-content">
<div class="otnotice-sections">
<section class="otnotice-section" id="otnotice-section-85ff159c-3ce1-4363-b5d9-cc14187d939c">
<div class="otnotice-section-content">
<p>If eligible, I understand and authorize the sharing of my personal health information by my pharmacy with Novo Nordisk, the sponsor of the Card, and its partners supporting the copay card programs as
necessary to: provide services to me under such programs; ensure effective administration and operations of such programs; transition my support; or share my information with servicer providers for the
purpose of aggregation or de-identification. This information may include the personal information provided by me for copay enrollment, payer-related information received from my health insurer, and
any prescription, fulfillment, and other information provided by my pharmacy. Should I begin receiving prescription benefits from a federal, state, or other government-funded program at any time, I will
no longer be eligible to participate in this program. You may also contact me periodically in order to verify that my eligibility for the program has not changed.</p>
<p><br></p>
</div>
</section>
</div>
<div class="otnotice-version"></div>
</div>
</div>
<script src="https://privacyportal-cdn.onetrust.com/privacy-notice-scripts/otnotice-1.0.min.js" type="text/javascript" charset="UTF-8" id="otprivacy-notice-script">
settings = "eyJjYWxsYmFja1VybCI6Imh0dHBzOi8vcHJpdmFjeXBvcnRhbC5vbmV0cnVzdC5jb20vcmVxdWVzdC92MS9wcml2YWN5Tm90aWNlcy9zdGF0cy92aWV3cyJ9"
</script>
<script type="text/javascript" charset="UTF-8">
// To ensure external settings are loaded, use the Initialized promise:
OneTrust.NoticeApi.Initialized.then(function() {
OneTrust.NoticeApi.LoadNotices(["https://privacyportal-cdn.onetrust.com/a59e08b2-1121-4ec5-8190-7e9b6f088bdf/privacy-notices/6111a539-acd2-44c8-8dbe-ab35ca6ce01c.json"]);
});
</script>
<!-- OneTrust Privacy Notice end -->
</div>
<style>
@media (min-width: 1224px) {
.htmlsource-1700488231017 {
margin-left: 0px;
}
}
</style>
</div>
<div class="checkboxfield aem-GridColumn aem-GridColumn--default--12">
<div class="checkboxfield-component left inp-comp" data-tagid="confirmation-yes" data-name="agreement" data-checkboxtext="<p style="font-size: 16.0px; line-height: 24.0px;"><strong>I agree</strong></p>
" data-askteriskposition="nex-to-label" data-width="is-full" data-chkboxstyle="chkbx-simple" data-mandatory="true" data-mandatoryerror="This is a required field" data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment"
data-gaeventaction="Field Interaction - Check Box" data-gaeventlabel="confirmation-yes" data-gaeventvalue="true">
<div class="form-grouped checkbox-inner-container chkbx-simple">
<div class="checkbox chkbx-simple is-full"><label for="confirmation-yes" class="chk-label"><input id="confirmation-yes" name="agreement" data-name="agreement" idvalidator="1c4ffbab-0181-4df8-85a8-c65ee2e8e001"
type="checkbox" fieldform="true" class="" data-value="false" data-nameid="agreement" data-description="I agree" autocomplete="off" value="true" aria-label="I agree"><span class="pseudo-style"></span><span
class="pl-2">
<p style="font-size: 16.0px; line-height: 24.0px;"><strong>I agree</strong><span class="req is-desktop-only">*</span></p>
</span></label></div>
</div>
</div>
</div>
<div class="horizontalbar aem-GridColumn aem-GridColumn--default--12">
<div class="hr-cmp">
<hr class="hr--primary--color border-0" style=" height:2px; margin-top:30px; margin-bottom:30px; background-color:#cccccc;">
</div>
</div>
</div>
</div>
</section>
</div>
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box " style="margin: 20px 0 0 0 !important; border: 1px solid #ffffff; ">
<div class="content-box-content container-fluid" style="padding-top: 20px; padding-right: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="htmlsource parbase aem-GridColumn aem-GridColumn--default--12">
<div class="htmlsourcetracking empty htmlsource-1700488231029">
<!-- OneTrust Privacy Notice start -->
<!-- Container in which the privacy notice will be rendered -->
<div id="otnotice-8568d706-16c8-4e1c-a77e-2d2a5c215a47" class="otnotice">
<div class="otnotice-content">
<div class="otnotice-sections">
<section class="otnotice-section" id="otnotice-section-02001f80-7c3c-4ca2-b036-ee6469299d4f">
<div class="otnotice-section-content">
<p>To complete your registration, we ask you to take a moment to read the below information to better understand how Novo Nordisk uses the information you provided us. When you finish reading, please
check the “I Agree” box and confirm your age. Then click SUBMIT to complete your registration</p>
</div>
</section>
</div>
<div class="otnotice-version"></div>
</div>
</div>
<script src="https://privacyportal-cdn.onetrust.com/privacy-notice-scripts/otnotice-1.0.min.js" type="text/javascript" charset="UTF-8" id="otprivacy-notice-script">
settings = "eyJjYWxsYmFja1VybCI6Imh0dHBzOi8vcHJpdmFjeXBvcnRhbC5vbmV0cnVzdC5jb20vcmVxdWVzdC92MS9wcml2YWN5Tm90aWNlcy9zdGF0cy92aWV3cyJ9"
</script>
<script type="text/javascript" charset="UTF-8">
// To ensure external settings are loaded, use the Initialized promise:
OneTrust.NoticeApi.Initialized.then(function() {
OneTrust.NoticeApi.LoadNotices(["https://privacyportal-cdn.onetrust.com/a59e08b2-1121-4ec5-8190-7e9b6f088bdf/privacy-notices/8568d706-16c8-4e1c-a77e-2d2a5c215a47.json"]);
});
</script>
<!-- OneTrust Privacy Notice end -->
<!-- OneTrust Privacy Notice start -->
<!-- Container in which the privacy notice will be rendered -->
<div id="otnotice-4d2454bc-d921-4165-8c7a-a4329c7a1ada" class="otnotice">
<div class="otnotice-content">
<div class="otnotice-sections">
<section class="otnotice-section" id="otnotice-section-335476d8-656c-4325-911b-613f9be76dcf">
<div class="otnotice-section-content">
<p>Novo Nordisk respects the importance of your privacy and understands your health is a very personal and sensitive subject. Novo Nordisk wants you to understand how it will use the information
provided by you on this registration page. By clicking “I Agree” below, you are indicating you want to learn more about this service and receive promotional or non-promotional updates via email or
mail from Novo Nordisk or its partners about products, support services, or other special opportunities that Novo Nordisk or its partners believe might be interesting to you. You also understand
that you may opt out from receiving any future communications from Novo Nordisk or its partners by clicking the “unsubscribe” link within any email you receive, by calling 1.877.744.2579, or by sending us
a letter containing your full contact information (e.g. name, email address, phone) to Novo Nordisk, 800 Scudders Mill Road, Plainsboro, New Jersey 08536.</p>
<p> </p>
<p>To better understand how Novo Nordisk values your privacy and what other information may be collected from you while you use this service, please see our
<a href="https://www.novonordisk-us.com/privacy-notice.html" target="_blank">Privacy Statement.</a></p>
</div>
</section>
</div>
<div class="otnotice-version"></div>
</div>
</div>
<script src="https://privacyportal-cdn.onetrust.com/privacy-notice-scripts/otnotice-1.0.min.js" type="text/javascript" charset="UTF-8" id="otprivacy-notice-script">
settings = "eyJjYWxsYmFja1VybCI6Imh0dHBzOi8vcHJpdmFjeXBvcnRhbC5vbmV0cnVzdC5jb20vcmVxdWVzdC92MS9wcml2YWN5Tm90aWNlcy9zdGF0cy92aWV3cyJ9"
</script>
<script type="text/javascript" charset="UTF-8">
// To ensure external settings are loaded, use the Initialized promise:
OneTrust.NoticeApi.Initialized.then(function() {
OneTrust.NoticeApi.LoadNotices(["https://privacyportal-cdn.onetrust.com/a59e08b2-1121-4ec5-8190-7e9b6f088bdf/privacy-notices/4d2454bc-d921-4165-8c7a-a4329c7a1ada.json"]);
});
</script>
<!-- OneTrust Privacy Notice end -->
</div>
<style>
@media (min-width: 1224px) {
.htmlsource-1700488231029 {
margin-left: 0px;
}
}
</style>
</div>
<div class="checkboxfield aem-GridColumn aem-GridColumn--default--12">
<div class="checkboxfield-component left inp-comp" data-tagid="agreement" data-name="terms-condition" data-alias="iagree" data-checkboxtext="<p style="font-size: 16.0px; line-height: 24.0px;"><strong>I agree and confirm I am 18 years of age or older</strong></p>
" data-askteriskposition="nex-to-label" data-width="is-full" data-chkboxstyle="chkbx-simple" data-mandatory="true" data-mandatoryerror="To continue, please confirm you are 18 years of age or older." data-gaeventvalue="false">
<div class="form-grouped checkbox-inner-container chkbx-simple">
<div class="checkbox chkbx-simple is-full"><label for="agreement" class="chk-label"><input id="agreement" name="terms-condition" data-name="terms-condition" idvalidator="76e5df8d-9b5a-46dc-82ff-5bfae8a408f3"
type="checkbox" fieldform="true" class="" data-value="false" data-nameid="terms-condition" data-description="I agree and confirm I am 18 years of age or older" autocomplete="off" value="true"
aria-label="I agree and confirm I am 18 years of age or older"><span class="pseudo-style"></span><span class="pl-2">
<p style="font-size: 16.0px; line-height: 24.0px;"><strong>I agree and confirm I am 18 years of age or older</strong><span class="req is-desktop-only">*</span></p>
</span></label></div>
</div>
</div>
</div>
</div>
</div>
</section>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:48px;">
</div>
</div>
<div class="submit aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="media__body">
<a id="getsavingscard-1551437295" href="#" class="btn btn-form-submit btn btn-cvi-compliance " data-tagid="getsavingscard" data-nameid="Next: Get savings offer" data-description="Next: Get savings offer" data-movetostep="1" data-gaeventvalue="false" data-web-service-error="Some error has occurred. Please try again." aria-label="Next: Get savings offer">
<p style="text-align: center;">Next: Get savings offer</p>
</a>
</div>
<p erroronsubmit="true" class="help-block small msg-error "></p>
</div>
<div class="experiencefragment aem-GridColumn aem-GridColumn--default--12">
<div>
<div class="xf-content-height">
<div class="aem-Grid aem-Grid--24 aem-Grid--default--24 ">
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="uMS" data-value="true" aria-hidden="true" role="none">
</div>
</div>
</div>
</div>
</div>
<div class="experiencefragment aem-GridColumn aem-GridColumn--default--12">
<div>
<div class="xf-content-height">
<div class="aem-Grid aem-Grid--24 aem-Grid--default--24 ">
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="uMS" data-value="true" aria-hidden="true" role="none">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
</div>
<input type="reset" value="Reset the form" class="hidden" aria-label="Reset the form" aria-hidden="true">
</fieldset>
</form>Name: dhc_form —
<form class="regform-body" novalidate="" name="dhc_form" data-name="dhc_form" data-data-binding="[]" data-endpoint=".pspCopayProgram.html" data-actiononsuccess="REDIRECT" data-webserviceerror="Some error has occurred. Please try again."
data-webservicefail="We're sorry, your account is currently unavailable. We're currently working to fix the issue. Please check back soon." data-valuetocancelredirect="nni:medication/type2/MEDTYPE/OZEMPIC-NO" data-offline="TRUE"
data-idsvalues="enrolledRadio Yes, I am enrolled=,enrolledRadio No, I am not enrolled=,commercialinsu Yes=,commercialinsu No=,Next: About me=,firstname=,lastname=,email=,dob=,languagePreferences English=,languagePreferences Spanish=,zip=,Next: Support=,prescribed Yes=,prescribed No=,sign-up-for-text-messages Yes=,sign-up-for-text-messages Not right now=,mobile-number=,phone-permission=,hipaaConsent I agree=,hipaaConsent I disagree=,Next: Confirm=,agreement=,terms-condition=,Next: Get savings offer=,pick_DHC Yes, sign me up!=,pick_DHC No thanks, I don’t want a free Health Coach.=,contact-number=,phProgramConsent=,Next=,sign-up-for-text-messages-radio Yes=,sign-up-for-text-messages-radio Not right now=">
<fieldset style="border-style: none;">
<legend class="sr-only"></legend>
<div name="initial-properties"></div>
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:30px;">
</div>
</div>
<div class="form-step experiencefragment aem-GridColumn aem-GridColumn--default--12">
<div class="form-step" data-tagid="dhc_1" data-name="Diabetes Health Coach" data-wait-to-execute="0" data-auto-submit-options="[]" style="">
<div class="xf-content-height">
<div class="aem-Grid aem-Grid--24 aem-Grid--default--24 ">
<div class="contentbox aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--24 aem-GridColumn--offset--default--0">
<section class="content-box ">
<div class="content-box-content container" style="padding-right: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid4aaf7065-2af0-498a-96cc-f642e9488868" class="">
<p style="font-size: 20.0px; line-height: 32.0px;"><strong>You’re eligible for FREE health coaching!</strong></p>
<p style="font-size: 16.0px; line-height: 24.0px;"><br> There’s no need to manage diabetes on your own when you have the support of a Diabetes Health Coach! Your <strong>FREE</strong> Health Coach is a real
person who is ready to assist via phone, text, or email on a schedule that’s convenient for you.</p>
<p style="font-size: 18.0px; line-height: 24.0px;"><strong>Your FREE Health Coach can help:</strong></p>
</div>
</div>
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488231227>img {
style="
padding-right: 10px;
padding-top: 10px;
padding-bottom: 10px;
"
: 30px;
}
.media-1700488231227>.media-body {}
.media-1700488231227>.media-body-content {}
@media (max-width: 991px) {
.media-1700488231227>img {}
.media-1700488231227>.media-body {}
.media-1700488231227>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488231227 m-normal-order flex-row flex-lg-row">
<img src="/content/dam/diabetes-patient/novocare/redesign/Slabs/Checkmark%20Icon.png" class="m-left m-top left top ">
<div class="media-body text-left m-left m-top text-lg-left left middle">
<p style="font-size: 16.0px;line-height: 24.0px;">Motivate you to set and reach your goals</p>
</div>
</div>
</div>
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488231230>img {
style="
padding-right: 10px;
padding-top: 10px;
padding-bottom: 10px;
"
: 30px;
}
.media-1700488231230>.media-body {}
.media-1700488231230>.media-body-content {}
@media (max-width: 991px) {
.media-1700488231230>img {}
.media-1700488231230>.media-body {}
.media-1700488231230>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488231230 m-normal-order flex-row flex-lg-row">
<img src="/content/dam/diabetes-patient/novocare/redesign/Slabs/Checkmark%20Icon.png" class="m-left m-top left top ">
<div class="media-body text-left m-left m-top text-lg-left left middle">
<p style="font-size: 16.0px;line-height: 24.0px;">Answer your questions one on one</p>
</div>
</div>
</div>
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488231232>img {
style="
padding-right: 10px;
padding-top: 10px;
padding-bottom: 10px;
"
: 30px;
}
.media-1700488231232>.media-body {}
.media-1700488231232>.media-body-content {}
@media (max-width: 991px) {
.media-1700488231232>img {}
.media-1700488231232>.media-body {}
.media-1700488231232>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488231232 m-normal-order flex-row flex-lg-row">
<img src="/content/dam/diabetes-patient/novocare/redesign/Slabs/Checkmark%20Icon.png" class="m-left m-top left top ">
<div class="media-body text-left m-left m-top text-lg-left left middle">
<p style="font-size: 16.0px;line-height: 24.0px;">Provide healthy eating and exercise tips</p>
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:30px;">
</div>
</div>
<div class="contentbox aem-GridColumn--phone--hide aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0">
<section class="content-box " style="border: 3px solid #C1C6C8; ">
<div class="content-box-content container" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="image aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--default--hide aem-GridColumn aem-GridColumn--offset--default--0 aem-GridColumn--default--4 aem-GridColumn--tablet--hide">
<div
data-cmp-src="/content/experience-fragments/brandbase/novocare/savings-card-t/rybelsus/dhc_1/master/_jcr_content/root/contentbox_copy/cbox-content/contentbox_142321317_1833558240/cbox-content/image_copy.bbcoreimg{.width}.png/1675891534625/novocare-dhcsavings-rybelsuslg.png"
data-asset="/content/dam/diabetes-patient/novocare/redesign/Slabs/Novocare_DHCsavings_RybelsusLG.png" data-asset-id="c0c2e8ea-e1b5-4cf7-bc32-08b21a8d9acc" class="cmp-image " itemscope=""
itemtype="http://schema.org/ImageObject">
<img src="/content/dam/diabetes-patient/novocare/redesign/Slabs/Novocare_DHCsavings_RybelsusLG.png" class="cmp-image__image" itemprop="contentUrl" data-cmp-hook-image="image" alt="" role="presentation">
</div>
</div>
<div class="mediaobject aem-GridColumn--phone--hide aem-GridColumn--default--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<style>
.media-1700488231249>img {
height: 356px;
}
.media-1700488231249>.media-body {}
.media-1700488231249>.media-body-content {}
@media (max-width: 991px) {
.media-1700488231249>img {}
.media-1700488231249>.media-body {}
.media-1700488231249>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488231249 m-normal-order flex-row flex-lg-row">
<img src="/content/dam/diabetes-patient/novocare/redesign/Slabs/Novocare_DHCsavings_Rybelsus.png" class="m-left m-top left top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div
class="contentbox aem-GridColumn--offset--tablet--0 aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn--tablet--none aem-GridColumn aem-GridColumn--tablet--8 aem-GridColumn--default--8 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<section class="content-box ">
<div class="content-box-content container" style="padding-top: 40px; padding-right: 40px; padding-bottom: 10px; padding-left: 40px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="verticalspacing parbase aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--10 aem-GridColumn--offset--default--1">
<div style="height:20px;">
</div>
</div>
<div
class="genericText aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div id="textidb712e3e1-2e0f-430c-87b0-19598707586e" class="">
<p style="font-size: 20px; line-height: 24px; text-align: left;"><strong>What current members say:</strong></p>
<p style="font-size: 16px; line-height: 24px; text-align: left;"><em>I’ve worked hard making small adjustments toward my goal. I’m actually looking forward to my next doctor appointment! <span
style="white-space: nowrap;">— Member</span></em></p>
</div>
</div>
<div class="horizontalbar aem-GridColumn aem-GridColumn--default--12">
<div class="hr-cmp">
<hr class="hr--primary--color border-0" style=" height:2px; margin-top:5px; margin-bottom:20px; background-color:#C1C6C8;">
</div>
</div>
<div class="genericText aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div id="textidbfb14636-186f-4f00-95b3-b4f2d0288cde" class="">
<p style="font-size: 16.0px; line-height: 24.0px;"><em>My Health Coach holds me accountable. Since starting this program I have felt like I can have a positive effect on my own health. — Member</em></p>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</section>
</div>
<div class="contentbox aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--default--hide aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0 aem-GridColumn--tablet--hide">
<section class="content-box " style="border: 3px solid #C1C6C8; ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="image aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--default--hide aem-GridColumn aem-GridColumn--offset--default--0 aem-GridColumn--default--4 aem-GridColumn--tablet--hide">
<div
data-cmp-src="/content/experience-fragments/brandbase/novocare/savings-card-t/rybelsus/dhc_1/master/_jcr_content/root/contentbox_copy/cbox-content/contentbox_142321317/cbox-content/image_copy.bbcoreimg{.width}.png/1675891534625/novocare-dhcsavings-rybelsuslg.png"
data-asset="/content/dam/diabetes-patient/novocare/redesign/Slabs/Novocare_DHCsavings_RybelsusLG.png" data-asset-id="c0c2e8ea-e1b5-4cf7-bc32-08b21a8d9acc" class="cmp-image " itemscope=""
itemtype="http://schema.org/ImageObject">
<img src="/content/dam/diabetes-patient/novocare/redesign/Slabs/Novocare_DHCsavings_RybelsusLG.png" class="cmp-image__image" itemprop="contentUrl" data-cmp-hook-image="image" alt="" role="presentation">
</div>
</div>
<div class="mediaobject aem-GridColumn--phone--hide aem-GridColumn--default--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<style>
.media-1700488231280>img {
height: 356px;
}
.media-1700488231280>.media-body {}
.media-1700488231280>.media-body-content {}
@media (max-width: 991px) {
.media-1700488231280>img {}
.media-1700488231280>.media-body {}
.media-1700488231280>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488231280 m-normal-order flex-row flex-lg-row">
<img src="/content/dam/diabetes-patient/novocare/redesign/Slabs/Novocare_DHCsavings_Rybelsus.png" class="m-left m-top left top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div
class="contentbox aem-GridColumn--offset--tablet--0 aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn--tablet--none aem-GridColumn aem-GridColumn--tablet--8 aem-GridColumn--default--8 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<section class="content-box ">
<div class="content-box-content container" style="padding-top: 40px; padding-right: 40px; padding-bottom: 10px; padding-left: 40px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="genericText aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div id="textidff4460ca-472c-457c-b669-c22bf367937e" class="">
<p style="font-size: 18px; line-height: 24px; text-align: center;"><strong>What current members say:</strong></p>
<p style="font-size: 16px; line-height: 24px; text-align: center;"><em>I’ve worked hard making small adjustments toward my goal. I’m actually looking forward to my next doctor appointment! <span
style="white-space: nowrap;">— Member</span></em></p>
</div>
</div>
<div class="horizontalbar aem-GridColumn aem-GridColumn--default--12">
<div class="hr-cmp">
<hr class="hr--primary--color border-0" style=" height:2px; margin-top:5px; margin-bottom:20px; background-color:#C1C6C8;">
</div>
</div>
<div class="genericText aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div id="textidf9c59b7f-c34b-490b-8d4d-2c0f0cf96d94" class="">
<p style="font-size: 16px; line-height: 24px; text-align: center;"><em>My Health Coach holds me accountable. Since starting this program I have felt like I can have a positive effect on my own health. —
Member</em></p>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</section>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:30px;">
</div>
</div>
<div class="radiogroup aem-GridColumn--phone--hide aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--newline aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div class="radiogroup-component rdo-default default radiogroup-1700488231296 default-rbtn inp-comp" data-name="pick_DHC" data-label="<p><strong>Would you like a FREE Diabetes Health Coach?</strong></p>
" data-options="[ {"uuid": "-1700386525", "parentValue": "", "tagid": "dhc-yes", "value": "yes", "text": "Yes, sign me up!", "accordionbody":"", "action": "show", "hiddenSection": "cde-options"} , {"uuid": "-1700386525", "parentValue": "", "tagid": "dhc-no", "value": "no", "text": "No thanks, I don’t want a free Health Coach.", "accordionbody":"", "action": "show", "hiddenSection": "|cde-options"}]"
data-optionstyle="rdo-default" data-required="true" data-fieldrequiredmessage="Please make a selection." data-gaeventvalue="false">
<div class="form-grouped"><label name="pick_DHC" data-name="pick_DHC" idvalidator="4f7c1ec6-0cfa-49ec-b5c8-483ad77b0c9f" data-value="" fieldform="true" class="control-label"><span>
<p><strong>Would you like a FREE Diabetes Health Coach?</strong><span class="req">*</span></p>
</span></label>
<fieldset>
<legend></legend><label class="radio" for="dhc-yes--1700386525"><input id="dhc-yes--1700386525" name="pick_DHC" type="radio" fieldform="true" data-nameid="pick_DHC Yes, sign me up!"
data-description="Would you like a FREE Diabetes Health Coach?" value="yes" aria-label="Would you like a FREE Diabetes Health Coach?"><span class="pl-2 radio-label">Yes, sign me up!</span><span
class="radio-circle"><span class="radio-checked"></span></span></label><label class="radio" for="dhc-no--1700386525"><input id="dhc-no--1700386525" name="pick_DHC" type="radio" fieldform="true"
data-nameid="pick_DHC No thanks, I don’t want a free Health Coach." data-description="Would you like a FREE Diabetes Health Coach?" value="no" aria-label="Would you like a FREE Diabetes Health Coach?"><span
class="pl-2 radio-label">No thanks, I don’t want a free Health Coach.</span><span class="radio-circle"><span class="radio-checked"></span></span></label>
</fieldset>
</div>
</div>
</div>
<div class="radiogroup aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--default--hide aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0 aem-GridColumn--tablet--hide">
<div class="radiogroup-component rdo-default default radiogroup-1700488231297 default-rbtn inp-comp" data-name="pick_DHC" data-label="<p><strong>Would you like a FREE Diabetes Health Coach?</strong></p>
" data-options="[ {"uuid": "-161396087", "parentValue": "", "tagid": "dhc-yes", "value": "yes", "text": "Yes, sign me up!", "accordionbody":"", "action": "show", "hiddenSection": "cde-options"} , {"uuid": "-161396087", "parentValue": "", "tagid": "dhc-no", "value": "no", "text": "No thanks, I don’t want a free Health Coach.", "accordionbody":"", "action": "show", "hiddenSection": "|cde-options"}]"
data-optionstyle="rdo-default" data-required="true" data-fieldrequiredmessage="Please make a selection." data-gaeventvalue="false">
<div class="form-grouped"><label name="pick_DHC" data-name="pick_DHC" idvalidator="cea902de-e414-4866-bf86-4fcb41338d87" data-value="" fieldform="true" class="control-label"><span>
<p><strong>Would you like a FREE Diabetes Health Coach?</strong><span class="req">*</span></p>
</span></label>
<fieldset>
<legend></legend><label class="radio" for="dhc-yes--161396087"><input id="dhc-yes--161396087" name="pick_DHC" type="radio" fieldform="true" data-nameid="pick_DHC Yes, sign me up!"
data-description="Would you like a FREE Diabetes Health Coach?" value="yes" aria-label="Would you like a FREE Diabetes Health Coach?"><span class="pl-2 radio-label">Yes, sign me up!</span><span
class="radio-circle"><span class="radio-checked"></span></span></label><label class="radio" for="dhc-no--161396087"><input id="dhc-no--161396087" name="pick_DHC" type="radio" fieldform="true"
data-nameid="pick_DHC No thanks, I don’t want a free Health Coach." data-description="Would you like a FREE Diabetes Health Coach?" value="no" aria-label="Would you like a FREE Diabetes Health Coach?"><span
class="pl-2 radio-label">No thanks, I don’t want a free Health Coach.</span><span class="radio-circle"><span class="radio-checked"></span></span></label>
</fieldset>
</div>
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="cde-options" data-control-state="0" data-state-value="1" data-open-options="[]">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="phonefield aem-GridColumn--phone--hide aem-GridColumn--default--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div class="phonefield-component inp-comp" data-tagid="phoneNumber-dhc-1" data-name="contact-number" data-alias="phone-number" data-label="<p><strong>What is the best phone number to reach you?</strong></p>
" data-width="is-two-fifths" data-required="true" data-fieldrequiredmessage="Please enter your phone number." data-fieldinvalidmessage="Please enter a valid phone number." data-gaeventvalue="false">
<div class="form-grouped"><label for="phoneNumber-dhc-1" class="control-label"><span>
<p><strong>What is the best phone number to reach you?</strong><span class="req">*</span></p>
</span></label>
<div class="input-grouped is-two-fifths"><input id="phoneNumber-dhc-1" name="contact-number" data-name="contact-number" idvalidator="ff4a2b0b-b61c-46dd-86e5-495a59c353f4" type="tel" fieldform="true"
class="form-field-control field-text-base" placeholder="" aria-label="What is the best phone number to reach you?" data-value="" data-nameid="contact-number"
data-description="What is the best phone number to reach you?" autocomplete="off" value="" im-insert="true"><span class="input-grouped-addon"></span></div>
<p class="help-block msg-waiting"><span class="rq-icon fa fa-spinner fa-spin"></span></p>
</div>
</div>
</div>
<div
class="phonefield aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--phone--none aem-GridColumn--default--hide aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--tablet--hide">
<div class="phonefield-component inp-comp" data-tagid="phoneNumber-dhc-1" data-name="contact-number" data-alias="phone-number" data-label="<p><strong>What is the best phone number to reach you?</strong></p>
" data-width="is-two-fifths" data-required="true" data-fieldrequiredmessage="Please enter your phone number." data-fieldinvalidmessage="Please enter a valid phone number." data-gaeventvalue="false">
<div class="form-grouped"><label for="phoneNumber-dhc-1" class="control-label"><span>
<p><strong>What is the best phone number to reach you?</strong><span class="req">*</span></p>
</span></label>
<div class="input-grouped is-two-fifths"><input id="phoneNumber-dhc-1" name="contact-number" data-name="contact-number" idvalidator="eb8ba488-6627-436b-aabb-ead41e2d2734" type="tel" fieldform="true"
class="form-field-control field-text-base" placeholder="" aria-label="What is the best phone number to reach you?" data-value="" data-nameid="contact-number"
data-description="What is the best phone number to reach you?" autocomplete="off" value="" im-insert="true"><span class="input-grouped-addon"></span></div>
<p class="help-block msg-waiting"><span class="rq-icon fa fa-spinner fa-spin"></span></p>
</div>
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid887f1ca8-f9e3-4664-86f4-410366d70cdb" class="">
<p style="margin-bottom: 0.0px;"><strong>Terms & Conditions*</strong></p>
</div>
</div>
<div
class="checkboxfield aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--newline aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div class="checkboxfield-component inp-comp" data-tagid="phProgramConsent" data-name="phProgramConsent" data-checkboxtext="<p>I certify and agree that I am at least 18 years of age, a US resident, and have read and understand the&nbsp;Diabetes Health Coach Program <a href="https://www.cornerstones4care.com/content/cornerstones4care/en/dhc-terms-of-use.html" target="_blank">Terms of Use</a>. I acknowledge that I do not have to agree to the&nbsp;Diabetes Health Coach Program Terms of Use, and that my health care provider will treat me regardless of whether I agree. However, if I do not agree, I will not be permitted to participate in the&nbsp;Diabetes Health Coach Program. My consent is not required to purchase other goods or receive additional services from Novo Nordisk. I also accept that the&nbsp;Diabetes Health Coach Program does not substitute for medical advice from my health care provider and that I will have to contact my health care provider directly about issues, questions, or concerns. I further recognize that the&nbsp;Diabetes Health Coach Program is not a means to communicate product issues or negative side effects to Novo Nordisk and that I should report negative side effects of prescription drugs to the FDA at www.fda.gov/medwatch or by phone at 1-800-FDA-1088. Novo Nordisk is not responsible for monitoring or recording text messages that may constitute an issue or negative side effect. However, if I am using a Novo Nordisk product as treatment and some of my entered responses can be interpreted as a side effect of the medication, Novo Nordisk reserves the right to contact me for more information by phone or written communication.</p>
" data-askteriskposition="nex-to-label" data-width="is-full" data-chkboxstyle="chkbx-simple" data-mandatory="true" data-mandatoryerror="This is a required field." data-gaeventvalue="false">
<div class="form-grouped checkbox-inner-container chkbx-simple">
<div class="checkbox chkbx-simple is-full"><label for="phProgramConsent" class="chk-label"><input id="phProgramConsent" name="phProgramConsent" data-name="phProgramConsent"
idvalidator="38093fc4-6289-4803-8f77-5c02b21c7a2a" type="checkbox" fieldform="true" class="" data-value="false" data-nameid="phProgramConsent"
data-description="I certify and agree that I am at least 18 years of age, a US resident, and have read and understand the&nbsp;Diabetes Health Coach Program Terms of Use. I acknowledge that I do not have to agree to the&nbsp;Diabetes Health Coach Program Terms of Use, and that my health care provider will treat me regardless of whether I agree. However, if I do not agree, I will not be permitted to participate in the&nbsp;Diabetes Health Coach Program. My consent is not required to purchase other goods or receive additional services from Novo Nordisk. I also accept that the&nbsp;Diabetes Health Coach Program does not substitute for medical advice from my health care provider and that I will have to contact my health care provider directly about issues, questions, or concerns. I further recognize that the&nbsp;Diabetes Health Coach Program is not a means to communicate product issues or negative side effects to Novo Nordisk and that I should report negative side effects of prescription drugs to the FDA at www.fda.gov/medwatch or by phone at 1-800-FDA-1088. Novo Nordisk is not responsible for monitoring or recording text messages that may constitute an issue or negative side effect. However, if I am using a Novo Nordisk product as treatment and some of my entered responses can be interpreted as a side effect of the medication, Novo Nordisk reserves the right to contact me for more information by phone or written communication."
autocomplete="off" value="true"
aria-label="I certify and agree that I am at least 18 years of age, a US resident, and have read and understand the&nbsp;Diabetes Health Coach Program Terms of Use. I acknowledge that I do not have to agree to the&nbsp;Diabetes Health Coach Program Terms of Use, and that my health care provider will treat me regardless of whether I agree. However, if I do not agree, I will not be permitted to participate in the&nbsp;Diabetes Health Coach Program. My consent is not required to purchase other goods or receive additional services from Novo Nordisk. I also accept that the&nbsp;Diabetes Health Coach Program does not substitute for medical advice from my health care provider and that I will have to contact my health care provider directly about issues, questions, or concerns. I further recognize that the&nbsp;Diabetes Health Coach Program is not a means to communicate product issues or negative side effects to Novo Nordisk and that I should report negative side effects of prescription drugs to the FDA at www.fda.gov/medwatch or by phone at 1-800-FDA-1088. Novo Nordisk is not responsible for monitoring or recording text messages that may constitute an issue or negative side effect. However, if I am using a Novo Nordisk product as treatment and some of my entered responses can be interpreted as a side effect of the medication, Novo Nordisk reserves the right to contact me for more information by phone or written communication."><span
class="pseudo-style"></span><span class="pl-2">
<p>I certify and agree that I am at least 18 years of age, a US resident, and have read and understand the Diabetes Health Coach Program
<a href="https://www.cornerstones4care.com/content/cornerstones4care/en/dhc-terms-of-use.html" target="_blank">Terms of Use</a>. I acknowledge that I do not have to agree to the Diabetes Health Coach
Program Terms of Use, and that my health care provider will treat me regardless of whether I agree. However, if I do not agree, I will not be permitted to participate in the Diabetes Health Coach
Program. My consent is not required to purchase other goods or receive additional services from Novo Nordisk. I also accept that the Diabetes Health Coach Program does not substitute for medical advice
from my health care provider and that I will have to contact my health care provider directly about issues, questions, or concerns. I further recognize that the Diabetes Health Coach Program is not a
means to communicate product issues or negative side effects to Novo Nordisk and that I should report negative side effects of prescription drugs to the FDA at www.fda.gov/medwatch or by phone at
1-800-FDA-1088. Novo Nordisk is not responsible for monitoring or recording text messages that may constitute an issue or negative side effect. However, if I am using a Novo Nordisk product as treatment and
some of my entered responses can be interpreted as a side effect of the medication, Novo Nordisk reserves the right to contact me for more information by phone or written communication.<span
class="req is-desktop-only">*</span></p>
</span></label></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="horizontalbar aem-GridColumn aem-GridColumn--default--12">
<div class="hr-cmp">
<hr class="hr--primary--color border-0" style=" height:2px; margin-bottom:30px; background-color:#ffffff;">
</div>
</div>
<div class="submit aem-GridColumn aem-GridColumn--default--newline aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="media__body">
<a id="nextFinish--1496797088" href="#" class="btn btn-form-submit btn btn-cvi-compliance " data-tagid="nextFinish" data-nameid="Next" data-description="Next" data-movetostep="1" data-gaeventvalue="false" data-web-service-error="Some error has occurred. Please try again." aria-label="Next">
<p style="text-align: center;">Next</p>
</a>
</div>
<p erroronsubmit="true" class="help-block small msg-error "></p>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
<div class="form-step experiencefragment aem-GridColumn aem-GridColumn--default--12">
<div class="form-step" data-tagid="dhc_2" data-name="RYBELSUS® Connect" data-wait-to-execute="0" data-auto-submit-options="[]" style="display: none;">
<div class="xf-content-height">
<div class="aem-Grid aem-Grid--24 aem-Grid--default--24 ">
<div class="contentbox aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--24 aem-GridColumn--offset--default--0">
<section class="content-box ">
<div class="content-box-content container">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="responsivegrid aem-GridColumn aem-GridColumn--default--12">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:20px;">
</div>
</div>
<div class="step-header aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div class="step-title">
<p style="font-size: 20.0px;line-height: 24.0px;"><strong>You’re eligible for FREE text support! </strong></p>
</div>
<p class="step-description"></p>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid7a414dea-d025-4e36-9fb7-adc1d9f94d81" class="">
<p style="font-size: 16.0px; line-height: 24.0px;"><strong>RYBELSUS<sup>®</sup> Connect is a FREE text program designed to help you start and stay on RYBELSUS<sup>®</sup>.<sup>a</sup></strong></p>
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textidb7f16225-f0c6-43f0-85ef-89863c2aa2b9" class="">
<p style="font-size: 12.0px; line-height: 16.0px; color: #4A4A4A;"><sup>a</sup>Message and data rates may apply. Check with your mobile service provider. Message frequency will be based on your selections. Text HELP to
21848 for help. Text STOP to 21848 to quit. See Terms and Conditions of Use at <a href="https://www.rybelsus.com/terms-and-conditions.html" target="_self">RYBELSUS.com</a>.</p>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:20px;">
</div>
</div>
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box " style="margin: 0px 0 0 0 !important; ">
<div class="content-box-content container-fluid" style="padding-top: 20px; padding-right: 0px; padding-bottom: 20px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div class="simplepanel parbase aem-GridColumn--phone--hide aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0">
<!--[if lte IE 8]>
<![endif]-->
<style>
.custom-section-4442f4f5446e4951ad2dfe97d8732388 {}
</style>
<div class="simple-panel-container empty section-simple-panel-component 0 custom-section-4442f4f5446e4951ad2dfe97d8732388 " style=" margin-top: 0px; padding-top: 0px; padding-right: 0px; padding-left: 0px; "
title="">
<!--TODO: check if this is necessary otherwise remove -->
<!-- Added hidden images to display meta data for PDF generator -->
<!-- Desktop Image -->
<div class="responsivegrid">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box " style="background-color: #A0CDEF;">
<div class="content-box-content container-fluid" style="padding-top: 4px; padding-right: 0px; padding-bottom: 4px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="genericText aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div id="textid2268164e-d534-491c-96ab-ae84bcaa60ea" class="">
<p style="text-align: center; font-size: 22.0px; line-height: 32.0px; margin: 0;">Here is what you will get with RYBELSUS<sup>®</sup> Connect:</p>
</div>
</div>
</div>
</div>
</section>
</div>
<div class="simplepanel parbase aem-GridColumn aem-GridColumn--default--12">
<!--[if lte IE 8]>
<![endif]-->
<style>
.custom-section-4af20919077d49f5bbac696898af4fcb {}
</style>
<div class="simple-panel-container empty section-simple-panel-component custom-section-4af20919077d49f5bbac696898af4fcb "
style=" background-color: #E2F0FA; padding-right: 40px; padding-left: 40px; " title="">
<!--TODO: check if this is necessary otherwise remove -->
<!-- Added hidden images to display meta data for PDF generator -->
<!-- Desktop Image -->
<div class="responsivegrid">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box ">
<div class="content-box-content container-fluid">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--6 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488231449>img {
width: 96px;
}
.media-1700488231449>.media-body {}
.media-1700488231449>.media-body-content {}
@media (max-width: 991px) {
.media-1700488231449>img {}
.media-1700488231449>.media-body {}
.media-1700488231449>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488231449 m-normal-order flex-row flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_reminders.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid8687861e-2eef-4814-b120-adde1f03cc88" class="">
<p style="text-align: center;"><span class="h7" style="color: #001965;"><strong>Medicine<br> reminders</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--6 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488231465>img {
width: 96px;
}
.media-1700488231465>.media-body {}
.media-1700488231465>.media-body-content {}
@media (max-width: 991px) {
.media-1700488231465>img {}
.media-1700488231465>.media-body {}
.media-1700488231465>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488231465 m-normal-order flex-row flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_info.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textiddb749942-4d77-4f3f-92ba-b32f340d710a" class="">
<p style="text-align: center;"><span class="h7" style="color: rgb(0,25,101);"><strong>Helpful<br> information</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--6 aem-GridColumn--offset--phone--3 aem-GridColumn aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488231479>img {
width: 96px;
}
.media-1700488231479>.media-body {}
.media-1700488231479>.media-body-content {}
@media (max-width: 991px) {
.media-1700488231479>img {}
.media-1700488231479>.media-body {}
.media-1700488231479>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488231479 m-normal-order flex-row flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_motivation.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textidbcb7e5b7-eb2f-4400-9304-dc03642460fe" class="">
<p style="text-align: center;"><span class="h7" style="color: rgb(0,25,101);"><strong>Motivational<br> messages</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div
class="contentbox aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--default--hide aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0 aem-GridColumn--tablet--hide">
<section class="content-box " style="background-color: #A0CDEF;">
<div class="content-box-content container-fluid" style="padding-top: 4px; padding-right: 0px; padding-bottom: 4px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="genericText aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div id="textide0a5627d-be2f-4401-bbf9-04a310c5468d" class="">
<p style="text-align: center; font-size: 22.0px; line-height: 32.0px; margin: 0;">Here is what you will get with RYBELSUS<sup>®</sup> Connect:</p>
</div>
</div>
</div>
</div>
</section>
</div>
<div
class="simplepanel parbase aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--default--hide aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0 aem-GridColumn--tablet--hide">
<!--[if lte IE 8]>
<![endif]-->
<style>
.custom-section-b055e26499be41ad82c321993d9025d2 {}
</style>
<div class="simple-panel-container empty section-simple-panel-component 0 custom-section-b055e26499be41ad82c321993d9025d2 "
style=" background-color: #E2F0FA; margin-top: 0px; padding-top: 0px; padding-right: 0px; padding-left: 0px; " title="">
<!--TODO: check if this is necessary otherwise remove -->
<!-- Added hidden images to display meta data for PDF generator -->
<!-- Desktop Image -->
<div class="responsivegrid">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="simplepanel parbase aem-GridColumn aem-GridColumn--default--12">
<!--[if lte IE 8]>
<![endif]-->
<style>
.custom-section-9ba67b3673cc4a7baca1ba428b2763da {}
</style>
<div class="simple-panel-container empty section-simple-panel-component custom-section-9ba67b3673cc4a7baca1ba428b2763da " style=" " title="">
<!--TODO: check if this is necessary otherwise remove -->
<!-- Added hidden images to display meta data for PDF generator -->
<!-- Desktop Image -->
<div class="responsivegrid">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-right: 0px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488231539>img {
width: 96px;
}
.media-1700488231539>.media-body {}
.media-1700488231539>.media-body-content {}
@media (max-width: 991px) {
.media-1700488231539>img {}
.media-1700488231539>.media-body {}
.media-1700488231539>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488231539 m-normal-order flex-column flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_reminders.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textidaa39526e-ce85-44e9-ae2f-31ed1c1702db" class="">
<p style="text-align: center;"><span class="h7" style="color: rgb(0,25,101);"><strong>Medicine reminders</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488231554>img {
width: 96px;
}
.media-1700488231554>.media-body {}
.media-1700488231554>.media-body-content {}
@media (max-width: 991px) {
.media-1700488231554>img {}
.media-1700488231554>.media-body {}
.media-1700488231554>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488231554 m-normal-order flex-column flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_info.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid641acb3f-cb3c-49f0-aebe-a010220dcce6" class="">
<p style="text-align: center;"><span class="h7" style="color: rgb(0,25,101);"><strong>Helpful information</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
<div
class="contentbox aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0 aem-GridColumn--default--4">
<section class="content-box ">
<div class="content-box-content container-fluid" style="padding-top: 0px; padding-right: 15px; padding-bottom: 0px; padding-left: 15px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="mediaobject aem-GridColumn aem-GridColumn--default--12">
<style>
.media-1700488231569>img {
width: 96px;
}
.media-1700488231569>.media-body {}
.media-1700488231569>.media-body-content {}
@media (max-width: 991px) {
.media-1700488231569>img {}
.media-1700488231569>.media-body {}
.media-1700488231569>.media-body-content {}
}
</style>
<div class="media d-flex media-1700488231569 m-normal-order flex-column flex-lg-column">
<img src="/content/dam/diabetes-patient/novocare/redesign/Icons/Novocare_icon_RYB_motivation.png" class="m-left m-top center top ">
<div class="media-body text-left m-left m-top text-lg-left left top">
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:15px;">
</div>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textid6f04c30a-de14-4edf-bfa0-3684f2724e84" class="">
<p style="text-align: center;"><span class="h7" style="color: rgb(0,25,101);"><strong>Motivational messages</strong></span></p>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</section>
</div>
<div class="verticalspacing parbase aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--12 aem-GridColumn--offset--default--0">
<div style="height:15px;">
</div>
</div>
<div class="radiogroup aem-GridColumn aem-GridColumn--default--12">
<div class="radiogroup-component rdo-default default radiogroup-1700488231576 default-rbtn inp-comp" data-name="sign-up-for-text-messages" data-label="<p><strong>Would you like to sign up for text messages?</strong></p>
" data-options="[ {"uuid": "-921119704", "parentValue": "", "tagid": "ryb-en-taking-sign-up-for-text-messages-yes-taking", "value": "yes", "text": "Yes", "accordionbody":"", "action": "show", "hiddenSection": "signup-section-dhc-2|no-signup-dhc-2"} , {"uuid": "-921119704", "parentValue": "", "tagid": "ryb-en-taking-sign-up-for-text-messages-no-taking", "value": "no", "text": "Not right now", "accordionbody":"", "action": "hide", "hiddenSection": "signup-section-dhc-2|no-signup-dhc-2"}]"
data-optionstyle="rdo-default" data-required="true" data-fieldrequiredmessage="Please make a selection." data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment"
data-gaeventaction="Field Interaction - Radio Button " data-gaeventlabel="sign-up-for-text-messages" data-gaeventvalue="true">
<div class="form-grouped"><label name="sign-up-for-text-messages" data-name="sign-up-for-text-messages" idvalidator="259370e5-a93d-4c8d-af89-ec5e92d7c018" data-value="" fieldform="true" class="control-label"><span>
<p><strong>Would you like to sign up for text messages?</strong><span class="req">*</span></p>
</span></label>
<fieldset>
<legend></legend><label class="radio" for="ryb-en-taking-sign-up-for-text-messages-yes-taking--921119704"><input id="ryb-en-taking-sign-up-for-text-messages-yes-taking--921119704" name="sign-up-for-text-messages"
type="radio" fieldform="true" data-nameid="sign-up-for-text-messages Yes" data-description="Would you like to sign up for text messages?" value="yes"
aria-label="Would you like to sign up for text messages?"><span class="pl-2 radio-label">Yes</span><span class="radio-circle"><span class="radio-checked"></span></span></label><label class="radio"
for="ryb-en-taking-sign-up-for-text-messages-no-taking--921119704"><input id="ryb-en-taking-sign-up-for-text-messages-no-taking--921119704" name="sign-up-for-text-messages" type="radio" fieldform="true"
data-nameid="sign-up-for-text-messages Not right now" data-description="Would you like to sign up for text messages?" value="no" aria-label="Would you like to sign up for text messages?"><span
class="pl-2 radio-label">Not right now</span><span class="radio-circle"><span class="radio-checked"></span></span></label>
</fieldset>
</div>
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="no-signup-dhc-2" data-control-state="0" data-state-value="1" data-open-options="[]">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textiddcbbb426-e752-45a8-b27f-e637439e6914" class="">
<p>Select “Confirm” below to continue on to get your savings offer. You may <strong>text READY to 21848</strong> anytime to start text support for RYBELSUS<sup>®</sup>.</p>
</div>
</div>
</div>
</div>
</div>
<div class="hidden-section aem-GridColumn aem-GridColumn--default--12">
<div class="hidden" data-name="signup-section-dhc-2" data-control-state="0" data-state-value="1" data-open-options="[]">
<div class="aem-Grid aem-Grid--12 aem-Grid--tablet--12 aem-Grid--default--12 aem-Grid--phone--12 ">
<div
class="phonefield aem-GridColumn--tablet--12 aem-GridColumn--offset--tablet--0 aem-GridColumn--default--none aem-GridColumn--phone--none aem-GridColumn--phone--12 aem-GridColumn--tablet--none aem-GridColumn aem-GridColumn--default--6 aem-GridColumn--offset--phone--0 aem-GridColumn--offset--default--0">
<div class="phonefield-component inp-comp" data-tagid="phoneNumber-dhc-2" data-name="contact-number" data-alias="mobile-number" data-label="<p>Mobile phone number</p>
" data-width="is-full" data-required="true" data-fieldrequiredmessage="Please enter a mobile phone number." data-fieldinvalidmessage="Please enter a valid mobile phone number." data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment"
data-gaeventaction="Field Interaction - Text Box" data-gaeventlabel="phoneNumber" data-gaeventvalue="true">
<div class="form-grouped"><label for="phoneNumber-dhc-2" class="control-label"><span>
<p>Mobile phone number<span class="req">*</span></p>
</span></label>
<div class="input-grouped is-full"><input id="phoneNumber-dhc-2" name="contact-number" data-name="contact-number" idvalidator="d523902f-1a75-4e84-a107-33a92cce9a75" type="tel" fieldform="true"
class="form-field-control field-text-base" placeholder="" aria-label="Mobile phone number" data-value="" data-nameid="contact-number" data-description="Mobile phone number" autocomplete="off" value=""
im-insert="true"><span class="input-grouped-addon"></span></div>
<p class="help-block msg-waiting"><span class="rq-icon fa fa-spinner fa-spin"></span></p>
</div>
</div>
</div>
<div class="contentbox aem-GridColumn aem-GridColumn--default--12">
<section class="content-box " style="border: 1px solid #ffffff; ">
<div class="content-box-content container-fluid" style="padding-right: 0px; padding-bottom: 20px; padding-left: 0px; ">
<div class="aem-Grid aem-Grid--12 aem-Grid--default--12 ">
<div class="checkboxfield aem-GridColumn aem-GridColumn--default--12">
<div class="checkboxfield-component inp-comp" data-tagid="rybelsus-sc-sms-opt-dhc" data-name="phone-permission" data-checkboxtext="<p>I would like Novo Nordisk to contact me via telephone and text message at the telephone number(s) I provided above regarding Novo Nordisk’s products, goods, or services. I understand these calls or texts may be generated using an automated technology and I do not have to consent to receive communications via telephone or text message before purchasing goods or receiving other services from Novo Nordisk.</p>
" data-hiddensection="hipaa-release" data-askteriskposition="nex-to-label" data-width="is-full" data-chkboxstyle="chkbx-simple" data-mandatory="true" data-mandatoryerror="This is a required field"
data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment" data-gaeventaction="Field Interaction - Check Box" data-gaeventlabel="confirm_reference" data-gaeventvalue="true">
<div class="form-grouped checkbox-inner-container chkbx-simple">
<div class="checkbox chkbx-simple is-full"><label for="rybelsus-sc-sms-opt-dhc" class="chk-label"><input id="rybelsus-sc-sms-opt-dhc" name="phone-permission" data-name="phone-permission"
idvalidator="e27c3bfa-6233-464b-aced-14aa2ed027bc" type="checkbox" fieldform="true" class="" data-value="false" data-nameid="phone-permission"
data-description="I would like Novo Nordisk to contact me via telephone and text message at the telephone number(s) I provided above regarding Novo Nordisk’s products, goods, or services. I understand these calls or texts may be generated using an automated technology and I do not have to consent to receive communications via telephone or text message before purchasing goods or receiving other services from Novo Nordisk."
autocomplete="off" value="true"
aria-label="I would like Novo Nordisk to contact me via telephone and text message at the telephone number(s) I provided above regarding Novo Nordisk’s products, goods, or services. I understand these calls or texts may be generated using an automated technology and I do not have to consent to receive communications via telephone or text message before purchasing goods or receiving other services from Novo Nordisk."><span
class="pseudo-style"></span><span class="pl-2">
<p>I would like Novo Nordisk to contact me via telephone and text message at the telephone number(s) I provided above regarding Novo Nordisk’s products, goods, or services. I understand these calls
or texts may be generated using an automated technology and I do not have to consent to receive communications via telephone or text message before purchasing goods or receiving other services
from Novo Nordisk.<span class="req is-desktop-only">*</span></p>
</span></label></div>
</div>
</div>
</div>
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="sign-up-for-text-messages" data-value="yes" aria-hidden="true" role="none">
</div>
</div>
</div>
</section>
</div>
<div class="genericText aem-GridColumn aem-GridColumn--default--12">
<div id="textide30ad70f-f79a-4a95-a31f-b7e506d9fb86" class="">
<p>Your personal health data may be shared by your pharmacy with Novo Nordisk and its partners. Once shared, you understand HIPAA may no longer protect your data. <strong>You do not need to answer “I agree” to get
the Savings Offer.</strong></p>
<p>Please review the <u><a href="https://www.rybelsus.com/content/dam/diabetes-patient/rybelsus/english/pdf/r-hipaa-waiver.pdf" target="Target">full waiver</a></u>.</p>
</div>
</div>
<div class="radiogroup aem-GridColumn aem-GridColumn--default--12">
<div class="radiogroup-component rdo-default default radiogroup-1700488231600 default-rbtn inp-comp" data-name="hipaaConsent" data-label="<p style="font-size: 16.0px; line-height: 24.0px;"><strong>Do you understand and agree to this data share?</strong></p>
" data-options="[ {"uuid": "-1714322397", "parentValue": "", "tagid": "agree-to-data-share-yes", "value": "yes", "text": "I agree", "accordionbody":"", "action": "show", "hiddenSection": "signup-section|no-signup"} , {"uuid": "-1714322397", "parentValue": "", "tagid": "agree-to-data-share-no", "value": "no", "text": "I disagree", "accordionbody":"", "action": "hide", "hiddenSection": "signup-section|no-signup"}]"
data-optionstyle="rdo-default" data-required="true" data-fieldrequiredmessage="Please make a selection." data-gaeventcategory="Rybelsus Patient - Saving Card Enrollment"
data-gaeventaction="Field Interaction - Radio Button " data-gaeventlabel="sign-up-for-text-messages" data-gaeventvalue="true">
<div class="form-grouped"><label name="hipaaConsent" data-name="hipaaConsent" idvalidator="a910628f-78f2-4513-8b70-30f83b8f8054" data-value="" fieldform="true" class="control-label"><span>
<p style="font-size: 16.0px; line-height: 24.0px;"><strong>Do you understand and agree to this data share?</strong><span class="req">*</span></p>
</span></label>
<fieldset>
<legend></legend><label class="radio" for="agree-to-data-share-yes--1714322397"><input id="agree-to-data-share-yes--1714322397" name="hipaaConsent" type="radio" fieldform="true"
data-nameid="hipaaConsent I agree" data-description="Do you understand and agree to this data share?" value="yes" aria-label="Do you understand and agree to this data share?"><span
class="pl-2 radio-label">I agree</span><span class="radio-circle"><span class="radio-checked"></span></span></label><label class="radio" for="agree-to-data-share-no--1714322397"><input
id="agree-to-data-share-no--1714322397" name="hipaaConsent" type="radio" fieldform="true" data-nameid="hipaaConsent I disagree" data-description="Do you understand and agree to this data share?" value="no"
aria-label="Do you understand and agree to this data share?"><span class="pl-2 radio-label">I disagree</span><span class="radio-circle"><span class="radio-checked"></span></span></label>
</fieldset>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="verticalspacing parbase aem-GridColumn aem-GridColumn--default--12">
<div style="height:40px;">
</div>
</div>
<div class="buttonComponent aem-GridColumn aem-GridColumn--default--12">
<style>
</style>
<div class="media__body" style=" ">
<a id="nextButton-b88462eb-9fc1-4e0f-98cc-d860a9cd7e7f" class="btn btn-cvi-compliance btn-inner-stepper " href="/diabetes/products/rybelsus/savings-offer.html" target="_self" style="display: inline-flex;" data-show-hide-action="true" data-scroll-into="" data-sections-name="dummy" data-form-action="" data-form-name="" data-btn-group-name="" data-step-to-go="1" data-trackingkey="" data-trackingvalue="" data-inner-stepper-section="taking-rybelsus-wrapper" data-form-name-main-flow="savings-card" data-field-values="[]" data-dynamic-url="">
<span class="icon-text ">
Next: Confirm
</span>
</a>
</div>
</div>
</div>
</div>
</div>
</div>
</section>
</div>
</div>
</div>
</div>
</div>
<div class="properties aem-GridColumn aem-GridColumn--default--12">
<input type="hidden" fieldform="true" name="medication" data-value="nni:medication/type2/MEDTYPE/RYBELSUS" aria-hidden="true" role="none">
</div>
</div>
<input type="reset" value="Reset the form" class="hidden" aria-label="Reset the form" aria-hidden="true">
</fieldset>
</form>Text Content
Important Safety Information Prescribing Information Support for Health Care Professionals Sign up for support Diabetes Home Products * Fiasp® (insulin aspart) injection 100 U/mL * Levemir® (insulin detemir) injection 100 U/mL * NovoLog® (insulin aspart) injection 100 U/mL * NovoLog® Mix 70/30 (insulin aspart protamine and insulin aspart) injectable suspension 100 U/mL * NovoPen Echo® * Ozempic® (semaglutide) injection 0.5 mg, 1 mg, or 2 mg * RYBELSUS® (semaglutide) tablets 7 mg or 14 mg * Tresiba® (insulin degludec) injection 100 U/mL or 200 U/mL * Victoza® (liraglutide) injection 1.2 mg or 1.8 mg * Xultophy® 100/3.6 (insulin degludec and liraglutide) injection 100 U/mL and 3.6 mg/mL * ZEGALOGUE® (dasiglucagon) injection 0.6 mg/0.6 mL Help with costs * OUR AFFORDABILITY PROGRAMS Our programs and offers may help reduce the cost of your insulin or provide it at no cost, depending on your situation. Use our tool to find helpful programs * Find help with insulin costs * Commitment to affordability * Savings offers * Patient Assistance Program Insurance information * CHECK YOUR INSURANCE COVERAGE Find out whether your health insurance covers your medication and get an estimated cost online in minutes. Get started * Check your insurance coverage * Exploring health insurance * About health insurance * Choosing a plan * Get to know the terms * Health insurance FAQs * Tips to make your plan work for you * Helpful resources * Types of health insurance * Commercial * Medicare * Medicaid * For those without insurance Diabetes education * DIABETES EDUCATION + RESOURCES Whether you just started a treatment, or you are a diabetes pro, Novo Nordisk provides education and resources that can help. Sign up for the latest updates * Sign up for the latest updates * Your diabetes journey * Eating * Healthy recipes * Moving * Managing diabetes * Staying on track with your plan * Diabetes and heart health * Social and emotional support * Support for caregivers * Glossary * Downloadable resources Resources * GET A FREE SHARPS DISPOSAL CONTAINER It’s important to properly dispose of your used Novo Nordisk products. Order your container online * Safe disposal resources * Public resources * Diabetes glossary * Health insurance terms * Downloadable resources Sign up for support Home Products BACK Products Fiasp® (insulin aspart) injection 100 U/mL BACK Home Check your insurance coverage Get a savings offer MyFiasp.com Levemir® (insulin detemir) injection 100 U/mL BACK Home Check your insurance coverage Levemir.com NovoLog® (insulin aspart) injection 100 U/mL BACK Home Check your insurance coverage Get a savings offer NovoLog.com NovoLog® Mix 70/30 (insulin aspart protamine and insulin aspart) injectable suspension 100 U/mL BACK Home Check your insurance coverage Get a savings offer NovoLogMix70-30.com NovoPen Echo® Ozempic® (semaglutide) injection 0.5 mg, 1 mg, or 2 mg BACK Home Check your insurance coverage Get a savings offer List price explained Sign up for support Ozempic.com RYBELSUS® (semaglutide) tablets 7 mg or 14 mg BACK Home Check your insurance coverage Get a savings offer List price explained Sign up for support RYBELSUS.com Tresiba® (insulin degludec) injection 100 U/mL or 200 U/mL BACK Home Check your insurance coverage Get a savings offer List price explained Sign up for support Tresiba.com Victoza® (liraglutide) injection 1.2 mg or 1.8 mg BACK Home Check your insurance coverage Victoza.com Xultophy® 100/3.6 (insulin degludec and liraglutide) injection 100 U/mL and 3.6 mg/mL BACK Home Check your insurance coverage Xultophy10036.com ZEGALOGUE® (dasiglucagon) injection 0.6 mg/0.6 mL BACK Home Get a savings offer ZEGALOGUE.com Help with costs BACK Help with costs Find help with insulin costs Commitment to affordability Savings offers Patient Assistance Program Insurance information BACK Insurance information Check your insurance coverage Exploring health insurance About health insurance Choosing a plan Get to know the terms Health insurance FAQs Tips to make your plan work for you Helpful resources Types of health insurance Commercial Medicare Medicaid For those without insurance Diabetes education BACK Diabetes education Sign up for the latest updates Your diabetes journey Eating Healthy recipes Moving Managing diabetes Staying on track with your plan Diabetes and heart health Social and emotional support Support for caregivers Glossary Downloadable resources Resources BACK Resources Safe disposal resources Public resources Diabetes glossary Health insurance terms Downloadable resources Sign up for support Important Safety Information Prescribing Information Support for Health Care Professionals Diabetes MENU CLOSE Check your insurance coverage Get a savings offer List price explained Sign up for support RYBELSUS.com Get RYBELSUS® savings and support Eligible patients with private or commercial insurance may pay as little as $10 for a 30-, 60-, or 90-day supply.a Sign up below to download a savings offer or text READY to 21848 to sign up for text-based savings and support.b ¿Habla español? Por favor, envié un SMS con la palabra LISTO al 21848 para inscribirse. aEligibility and other restrictions apply. bMessage and data rates may apply. Check with your mobile service provider. Message frequency will be based on your selections. Text HELP to 21848 for help. Text STOP to 21848 to quit. See Terms and Conditions of Use at RYBELSUS.com. Get RYBELSUS® savings and support Eligible patients with private or commercial insurance may pay as little as $10 for a 30-, 60-, or 90-day supply.a Sign up below to download a savings offer or text READY to 21848 to sign up for text-based savings and support.b ¿Habla español? Por favor, envié un SMS con la palabra LISTO al 21848 para inscribirse. aEligibility and other restrictions apply. bMessage and data rates may apply. Check with your mobile service provider. Message frequency will be based on your selections. Text HELP to 21848 for help. Text STOP to 21848 to quit. See Terms and Conditions of Use at RYBELSUS.com. GET RYBELSUS® SAVINGS AND SUPPORT * 1. Eligibility * 2. About me * 3. Support * 4. Confirmation *Indicates required field. *Indicates required field. Let's get started Let's get started Are you enrolled in any government, state, or federally funded medical or prescription benefit programs? (Examples include but are not limited to Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program.)* Yes, I am enrolledNo, I am not enrolled We’re sorry, but you are not eligible to participate in this program because you currently participate in a government, state, or federally funded prescription benefit program. However, you can still get support by signing up for text messages about RYBELSUS®. -------------------------------------------------------------------------------- Do you have commercial (also known as private) insurance that covers your prescription? (Insurance provided through an employer)* YesNo We’re sorry, but you must be enrolled in a commercial insurance plan to participate in this program. However, you can still get support by signing up for text messages about RYBELSUS®. -------------------------------------------------------------------------------- Next: About me Tell us about yourself First name* Last name* Email address* Checking for an existing SaxendaCare® account Date of birth* Language preference* EnglishSpanish ZIP code* -------------------------------------------------------------------------------- Next: Support Here is what you will get with RYBELSUS® Connect: Medicine reminders Helpful information Motivational messages GET PERSONALIZED SUPPORT To help tailor your support experience, we need to know some basic information about how your type 2 diabetes is being treated. Please know that you do not need to sign up for support in order to get your savings offer. Are you on RYBELSUS®?* YesNo -------------------------------------------------------------------------------- You’re eligible for FREE text support! RYBELSUS® Connect is a FREE text program designed to help you start and stay on RYBELSUS®.a aMessage and data rates may apply. Check with your mobile service provider. Message frequency will be based on your selections. Text HELP to 21848 for help. Text STOP to 21848 to quit. See Terms and Conditions of Use at RYBELSUS.com. Here is what you will get with RYBELSUS® Connect: Medicine reminders Helpful information Motivational messages Medicine reminders Helpful information Motivational messages Would you like to sign up for text messages?* YesNot right now Select “Confirm” below to continue on to get your savings offer. You may text READY to 21848 anytime to start text support for RYBELSUS®. Mobile phone number* I would like Novo Nordisk to contact me via telephone and text message at the telephone number(s) I provided above regarding Novo Nordisk’s products, goods, or services. I understand these calls or texts may be generated using an automated technology and I do not have to consent to receive communications via telephone or text message before purchasing goods or receiving other services from Novo Nordisk.* Your personal health data may be shared by your pharmacy with Novo Nordisk and its partners. Once shared, you understand HIPAA may no longer protect your data. You do not need to answer “I agree” to get the Savings Offer. Please review the full waiver. Do you understand and agree to this data share?* I agreeI disagree Next: Confirm Confirmation Registration is not complete until you indicate if you agree to each of the following statements If eligible, I understand and authorize the sharing of my personal health information by my pharmacy with Novo Nordisk, the sponsor of the Card, and its partners supporting the copay card programs as necessary to: provide services to me under such programs; ensure effective administration and operations of such programs; transition my support; or share my information with servicer providers for the purpose of aggregation or de-identification. This information may include the personal information provided by me for copay enrollment, payer-related information received from my health insurer, and any prescription, fulfillment, and other information provided by my pharmacy. Should I begin receiving prescription benefits from a federal, state, or other government-funded program at any time, I will no longer be eligible to participate in this program. You may also contact me periodically in order to verify that my eligibility for the program has not changed. I agree* -------------------------------------------------------------------------------- To complete your registration, we ask you to take a moment to read the below information to better understand how Novo Nordisk uses the information you provided us. When you finish reading, please check the “I Agree” box and confirm your age. Then click SUBMIT to complete your registration Novo Nordisk respects the importance of your privacy and understands your health is a very personal and sensitive subject. Novo Nordisk wants you to understand how it will use the information provided by you on this registration page. By clicking “I Agree” below, you are indicating you want to learn more about this service and receive promotional or non-promotional updates via email or mail from Novo Nordisk or its partners about products, support services, or other special opportunities that Novo Nordisk or its partners believe might be interesting to you. You also understand that you may opt out from receiving any future communications from Novo Nordisk or its partners by clicking the “unsubscribe” link within any email you receive, by calling 1.877.744.2579, or by sending us a letter containing your full contact information (e.g. name, email address, phone) to Novo Nordisk, 800 Scudders Mill Road, Plainsboro, New Jersey 08536. To better understand how Novo Nordisk values your privacy and what other information may be collected from you while you use this service, please see our Privacy Statement. I agree and confirm I am 18 years of age or older* Next: Get savings offer Here is what you will get with RYBELSUS® Connect: Medicine reminders Helpful information Motivational messages -------------------------------------------------------------------------------- * Diabetes Health Coach * RYBELSUS® Connect You’re eligible for FREE health coaching! There’s no need to manage diabetes on your own when you have the support of a Diabetes Health Coach! Your FREE Health Coach is a real person who is ready to assist via phone, text, or email on a schedule that’s convenient for you. Your FREE Health Coach can help: Motivate you to set and reach your goals Answer your questions one on one Provide healthy eating and exercise tips What current members say: I’ve worked hard making small adjustments toward my goal. I’m actually looking forward to my next doctor appointment! — Member -------------------------------------------------------------------------------- My Health Coach holds me accountable. Since starting this program I have felt like I can have a positive effect on my own health. — Member What current members say: I’ve worked hard making small adjustments toward my goal. I’m actually looking forward to my next doctor appointment! — Member -------------------------------------------------------------------------------- My Health Coach holds me accountable. Since starting this program I have felt like I can have a positive effect on my own health. — Member Would you like a FREE Diabetes Health Coach?* Yes, sign me up!No thanks, I don’t want a free Health Coach. Would you like a FREE Diabetes Health Coach?* Yes, sign me up!No thanks, I don’t want a free Health Coach. What is the best phone number to reach you?* What is the best phone number to reach you?* Terms & Conditions* I certify and agree that I am at least 18 years of age, a US resident, and have read and understand the Diabetes Health Coach Program Terms of Use. I acknowledge that I do not have to agree to the Diabetes Health Coach Program Terms of Use, and that my health care provider will treat me regardless of whether I agree. However, if I do not agree, I will not be permitted to participate in the Diabetes Health Coach Program. My consent is not required to purchase other goods or receive additional services from Novo Nordisk. I also accept that the Diabetes Health Coach Program does not substitute for medical advice from my health care provider and that I will have to contact my health care provider directly about issues, questions, or concerns. I further recognize that the Diabetes Health Coach Program is not a means to communicate product issues or negative side effects to Novo Nordisk and that I should report negative side effects of prescription drugs to the FDA at www.fda.gov/medwatch or by phone at 1-800-FDA-1088. Novo Nordisk is not responsible for monitoring or recording text messages that may constitute an issue or negative side effect. However, if I am using a Novo Nordisk product as treatment and some of my entered responses can be interpreted as a side effect of the medication, Novo Nordisk reserves the right to contact me for more information by phone or written communication.* -------------------------------------------------------------------------------- Next You’re eligible for FREE text support! RYBELSUS® Connect is a FREE text program designed to help you start and stay on RYBELSUS®.a aMessage and data rates may apply. Check with your mobile service provider. Message frequency will be based on your selections. Text HELP to 21848 for help. Text STOP to 21848 to quit. See Terms and Conditions of Use at RYBELSUS.com. Here is what you will get with RYBELSUS® Connect: Medicine reminders Helpful information Motivational messages Here is what you will get with RYBELSUS® Connect: Medicine reminders Helpful information Motivational messages Would you like to sign up for text messages?* YesNot right now Select “Confirm” below to continue on to get your savings offer. You may text READY to 21848 anytime to start text support for RYBELSUS®. Mobile phone number* I would like Novo Nordisk to contact me via telephone and text message at the telephone number(s) I provided above regarding Novo Nordisk’s products, goods, or services. I understand these calls or texts may be generated using an automated technology and I do not have to consent to receive communications via telephone or text message before purchasing goods or receiving other services from Novo Nordisk.* Your personal health data may be shared by your pharmacy with Novo Nordisk and its partners. Once shared, you understand HIPAA may no longer protect your data. You do not need to answer “I agree” to get the Savings Offer. Please review the full waiver. Do you understand and agree to this data share?* I agreeI disagree Next: Confirm Get text message support with RYBELSUS® Connect Text READY to 21848 for text messages to help you start and stay on RYBELSUS®.c Medicine reminders Helpful information Motivational messages cMessage and data rates may apply. Check with your mobile service provider. Message frequency will be based on your selections. Text HELP to 21848 for help. Text STOP to 21848 to quit. See Terms and Conditions of Use at RYBELSUS.com. Get text message support with RYBELSUS® Connect Text READY to 21848 for text messages to help you start and stay on RYBELSUS®.b Get text message support with RYBELSUS® Connect Text READY to 21848 for text messages to help you start and stay on RYBELSUS®.c Medicine reminders Helpful information Motivational messages cMessage and data rates may apply. Check with your mobile service provider. Message frequency will be based on your selections. Text HELP to 21848 for help. Text STOP to 21848 to quit. See Terms and Conditions of Use at RYBELSUS.com. × Está usted entrando a NovoCare.com, un recurso para ahorros y apoyo Si cuenta con un seguro comercial o privado y le gustaría solicitar una tarjeta de ahorros en nuestro sitio web, será necesario que llene un formulario en inglés. Si desea continuar la experiencia en español, envíe un mensaje de texto con la palabra LISTO al 21848 para inscribirse en ahorros y apoyo mediante mensajes de texto.a También puede llamar al 1-833-275-2233 para hablar con un representante que le ayudará a registrar su tarjeta de ahorros. Pasar al formulario aPueden aplicarse tarifas por los mensajes y datos. Consulte a su proveedor de servicios móviles. La frecuencia de los mensajes se basará en sus selecciones. Para solicitar ayuda, envíe AYUDA al 21848. Para finalizar, envíe CANCELAR al 21848. Consulte los Términos y Condiciones de Uso en RYBELSUS.com. NovoCare_Rybelsus_v01 Skip to main content IMPORTANT SAFETY INFORMATION FOR RYBELSUS® WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT RYBELSUS®? RYBELSUS® may cause serious side effects, including: * Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, RYBELSUS® and medicines that work like RYBELSUS® caused thyroid tumors, including thyroid cancer. It is not known if RYBELSUS® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people Do not use RYBELSUS® if: * you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) * you have had a serious allergic reaction to semaglutide or any of the ingredients in RYBELSUS®. See symptoms of serious allergic reaction in “What are the possible side effects of RYBELSUS®?” WHAT IS RYBELSUS®? RYBELSUS® (semaglutide) tablets 7 mg or 14 mg is a prescription medicine used along with diet and exercise to improve blood sugar (glucose) in adults with type 2 diabetes. * It is not known if RYBELSUS® can be used in people who have had pancreatitis * RYBELSUS® is not for use in people with type 1 diabetes * It is not known if RYBELSUS® is safe and effective for use in children under 18 years of age IMPORTANT SAFETY INFORMATION Before using RYBELSUS®, tell your healthcare provider if you have any other medical conditions, including if you: * have or have had problems with your pancreas or kidneys * have a history of vision problems related to your diabetes * are pregnant or plan to become pregnant. It is not known if RYBELSUS® will harm your unborn baby. You should stop using RYBELSUS® 2 months before you plan to become pregnant. Talk to your healthcare provider about the best way to control your blood sugar if you plan to become pregnant or while you are pregnant * are breastfeeding or plan to breastfeed. Breastfeeding is not recommended during treatment with RYBELSUS® Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. RYBELSUS® may affect the way some medicines work and some medicines may affect the way RYBELSUS® works. HOW SHOULD I TAKE RYBELSUS®? * Take RYBELSUS® exactly as your healthcare provider tells you to * Take RYBELSUS® by mouth on an empty stomach when you first wake up with a sip of plain water (no more than 4 ounces) * Do not split, crush, or chew. Swallow RYBELSUS® whole * After 30 minutes, you can eat, drink, or take other oral medicines * If you miss a dose of RYBELSUS®, skip the missed dose and go back to your regular schedule WHAT ARE THE POSSIBLE SIDE EFFECTS OF RYBELSUS®? RYBELSUS® may cause serious side effects, including: * inflammation of your pancreas (pancreatitis). Stop using RYBELSUS® and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back * changes in vision. Tell your healthcare provider if you have changes in vision during treatment with RYBELSUS® * low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use RYBELSUS® with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include: dizziness or lightheadedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, and feeling jittery * kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration * serious allergic reactions. Stop using RYBELSUS® and get medical help right away, if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat * gallbladder problems. Gallbladder problems have happened in some people who take RYBELSUS®. Tell your healthcare provider right away if you get symptoms of gallbladder problems, which may include: pain in your upper stomach (abdomen), yellowing of skin or eyes (jaundice), fever, and clay-colored stools The most common side effects of RYBELSUS® may include nausea, stomach (abdominal) pain, diarrhea, decreased appetite, vomiting, and constipation. Nausea, vomiting, and diarrhea are most common when you first start RYBELSUS®. Please see Prescribing Information and Medication Guide for RYBELSUS®. RYBELSUS® is a prescription medication. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088. × YOU ARE NOW LEAVING NOVOCARE.COM NovoCare® provides online resources that help you check your coverage, manage the cost of medicines, and more. Clicking “continue” below will take you to a website to which our Privacy Policy does not apply. Links are provided as a public service and for informational purposes only. No endorsement is made or implied. Continue Return to NovoCare.com Privacy policy Cookie policy Privacy request Contact us Novo Nordisk US Privacy policy Cookie policy Privacy request Contact us Novo Nordisk US NovoCare® and RYBELSUS® are registered trademarks of Novo Nordisk A/S. Novo Nordisk is a registered trademark of Novo Nordisk A/S. All other trademarks, registered or unregistered, are the property of their respective owners. © 2023 Novo Nordisk All rights reserved. US22NC00034 February 2023 Close You are being redirected to an another page. Do you wish to continue ? * Yes * No × Loading.... Novo Nordisk values your privacy and is committed to the transparent use of your personal information. We use cookies to improve the functionality and performance of this site, other cookies are used to remember your preferences or to share relevant content with you. By clicking “Accept All Cookies,” you consent to our recommended use of cookies in accordance with our Cookie Policy and Privacy Policy. You can also “Reject All” which leaves only strictly necessary cookies to enable website functionality. You can always review, modify, or revoke your consent by clicking “Customize Cookies.” Accept All Cookies Reject All Customize Cookies COOKIE PREFERENCE CENTER * YOUR PRIVACY * STRICTLY NECESSARY COOKIES * FUNCTIONALITY COOKIES * PERFORMANCE COOKIES * ADVERTISING COOKIES YOUR PRIVACY When you visit any website, it may store or retrieve information on your browser, often in the form of cookies. This information might be about your preferences or your device and is mostly used to make the site work as you expect it to. The information does not identify you, but it can give you a more personalized web experience. Because we respect your right to privacy, you can choose whether to allow or disallow certain categories of cookies on Novo Nordisk websites. Click on the different category headings to the left to find out more about these cookies do and change which cookies categories you allow. However, understand that blocking some types of cookies may impact your experience of the site and the services we are able to offer. More information STRICTLY NECESSARY COOKIES Always Active These cookies are required for the operation of our website and cannot be switched off without impairing the functionality of the site. Strictly necessary cookies are set to respond to actions you take, including navigating our site and using its basics features. These cookies do not store any Personal Information. FUNCTIONALITY COOKIES Functionality Cookies Active Allow our websites to remember your user name, language preference, or geographic region. This information is used to provide a personalised experience and to make the website easier to use. If you don’t allow these cookies, then some or all features may not function. PERFORMANCE COOKIES Performance Cookies Active Collect information about your use of our website, e.g. page visits or error messages. This information is aggregated and anonymized and used to improve our website. If you don’t allow these cookies, we won’t know when you have visited our website and won’t be able to monitor its performance. ADVERTISING COOKIES Advertising Cookies Active Allow us to display advertising we think is relevant to you. We build profiles based on your browsing history, which we share with our advertising partners to show you relevant advertisements on other sites. If you don’t allow these cookies you will still receive advertising, but it will be less relevant. Back Button COOKIE LIST Filter Button Consent Leg.Interest checkbox label label checkbox label label checkbox label label Clear checkbox label label Apply Cancel Confirm My Choices Reject All Allow All NovoCare_Rybelsus_v01 Skip to main content IMPORTANT SAFETY INFORMATION FOR RYBELSUS® WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT RYBELSUS®? RYBELSUS® may cause serious side effects, including: * Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, RYBELSUS® and medicines that work like RYBELSUS® caused thyroid tumors, including thyroid cancer. It is not known if RYBELSUS® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people Do not use RYBELSUS® if: * you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) * you have had a serious allergic reaction to semaglutide or any of the ingredients in RYBELSUS®. See symptoms of serious allergic reaction in “What are the possible side effects of RYBELSUS®?” WHAT IS RYBELSUS®? RYBELSUS® (semaglutide) tablets 7 mg or 14 mg is a prescription medicine used along with diet and exercise to improve blood sugar (glucose) in adults with type 2 diabetes. * It is not known if RYBELSUS® can be used in people who have had pancreatitis * RYBELSUS® is not for use in people with type 1 diabetes * It is not known if RYBELSUS® is safe and effective for use in children under 18 years of age IMPORTANT SAFETY INFORMATION Before using RYBELSUS®, tell your healthcare provider if you have any other medical conditions, including if you: * have or have had problems with your pancreas or kidneys * have a history of vision problems related to your diabetes * are pregnant or plan to become pregnant. It is not known if RYBELSUS® will harm your unborn baby. You should stop using RYBELSUS® 2 months before you plan to become pregnant. Talk to your healthcare provider about the best way to control your blood sugar if you plan to become pregnant or while you are pregnant * are breastfeeding or plan to breastfeed. Breastfeeding is not recommended during treatment with RYBELSUS® Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. RYBELSUS® may affect the way some medicines work and some medicines may affect the way RYBELSUS® works. HOW SHOULD I TAKE RYBELSUS®? * Take RYBELSUS® exactly as your healthcare provider tells you to * Take RYBELSUS® by mouth on an empty stomach when you first wake up with a sip of plain water (no more than 4 ounces) * Do not split, crush, or chew. Swallow RYBELSUS® whole * After 30 minutes, you can eat, drink, or take other oral medicines * If you miss a dose of RYBELSUS®, skip the missed dose and go back to your regular schedule WHAT ARE THE POSSIBLE SIDE EFFECTS OF RYBELSUS®? RYBELSUS® may cause serious side effects, including: * inflammation of your pancreas (pancreatitis). Stop using RYBELSUS® and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back * changes in vision. Tell your healthcare provider if you have changes in vision during treatment with RYBELSUS® * low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use RYBELSUS® with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include: dizziness or lightheadedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, and feeling jittery * kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration * serious allergic reactions. Stop using RYBELSUS® and get medical help right away, if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat * gallbladder problems. Gallbladder problems have happened in some people who take RYBELSUS®. Tell your healthcare provider right away if you get symptoms of gallbladder problems, which may include: pain in your upper stomach (abdomen), yellowing of skin or eyes (jaundice), fever, and clay-colored stools The most common side effects of RYBELSUS® may include nausea, stomach (abdominal) pain, diarrhea, decreased appetite, vomiting, and constipation. Nausea, vomiting, and diarrhea are most common when you first start RYBELSUS®. Please see Prescribing Information and Medication Guide for RYBELSUS®. RYBELSUS® is a prescription medication. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‑800‑FDA‑1088.