Diabetes Supply Assistance

INSTRUCTIONS: The Diabetes Foundation (DF) assists uninsured and underinsured New Jersey residents who are unable to pay for diabetes supplies due to financial hardship. DF’s Supply Assistance Program is an, emergency service that will be provided for up to sixty days to bridge the gap until a long-term solution can be obtained. DF also maintains a toll-free support network, which is available to supply recipients and others who may have questions or need ongoing resources for obtaining prescriptions, medical care, daily diabetes management, and more. The DF reserves the right to contact you with follow-up questions prior to the application being approved. Processing of applications takes place M-F 9-5. Once approved, delivery to a participant’s doorstep takes 4-7 days. If you need assistance filling this application, please call (201) 444-0337.

APPLICATION REQUIREMENTS:

• A document displaying proof of address must be provided (i.e. copy of driver's license, utility bill, phone bill, invoice, hospital face sheet etc.).
• Applicants must be residents of the state of New Jersey in order to receive assistance.
• A document displaying proof of need must be provided (i.e. unemployment documentation, tax return citing no insurance, healthcare professional letter explaining need etc.).
• Prescriptions required for syringes, pen needles, Omnipod pods, Freestyle Libre Sensors and Dexcom Transmitter and Sensors- copies are acceptable.
• The prescriptions MUST be written for a quantity of 2 months or 60 days and dated within the past 3 weeks of application submission.
• Copies of both sides of the applicant's insurance card(s) if they currently possess private/employer insurance, Affordable Care Act insurance, Medicare, Medicaid etc. (NOTE: This does not disqualify the applicant from the program)

*Incomplete applications will be held until al required documents have been provided*

• Each application will be reviewed on a case-by-case basis so that DF can determine the most effective way to assist the applicant for the short-term, as well as the long-term. In some situations, applicants may be deemed as better qualified to speak directly with one of our Diabetes Resource solutions prior to receiving supplies.

PRESCRIPTION REQUIREMENTS (only needed for pen needles, syringes, Omnipod pods and CGM sensors and transmitter): • Please make sure to write prescriptions for a 60 day or 2-month supply so DF can provide 2 months of supply assistance. • Medical Facility can fax prescriptions directly to 201-444-5580 • Pictures and copies of prescriptions are accepted • Please make sure prescriptions are up to date; we will not accept prescriptions past 3 weeks of date written on prescription