Help patients access EPIDIOLEX^®

(cannabidiol)

Jazz Pharmaceuticals is committed to making EPIDIOLEX affordable and accessible for patients by working with payers to reduce or eliminate reimbursement hurdles.

EPIDIOLEX Copay Savings Program

Eligible* commercially insured patients may pay as low as $0 per prescription

Download this helpful copay savings reminder for your patients and their caregivers.

*Eligibility criteria:

• A legal resident of the United States or Puerto Rico
• Commercially insured (patients are not eligible for this program if they are receiving prescription reimbursement for EPIDIOLEX under Medicare Part D, Medicaid, Medigap, VA/DoD (Tricare) programs, the Indian Health Service, or any other federal or state-funded healthcare program, or where prohibited by law)

This offer is subject to change or discontinuation at any time without notice. Other restrictions, including monthly and/or annual maximum limits, may apply.

See below for full terms and conditions. No enrollment is required. Eligibility is assessed as part of the standard benefit investigation process performed by the pharmacy. Any copay benefit will be automatically deducted from the patient’s copay. The copay savings program is not prescription coverage or insurance. Patients cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this program.

Full terms and conditions
Eligible patients may pay as low as $0 per EPIDIOLEX prescription. Monthly and/or annual maximum limits may apply. The copay savings program is only available for residents of the United States or Puerto Rico with a domestic mailing address (no P.O. boxes) who have commercial insurance coverage with out-of-pocket expenses, including copayments, co-insurance, and deductibles. The copay savings program is not valid for beneficiaries of Medicare, Medicaid, VA/DoD (Tricare) programs, the Indian Health Service or other federal or state healthcare programs, if patient pays for prescription in cash or if patient chooses not to use their insurance coverage. The copay savings program requires a valid, signed prescription for EPIDIOLEX. The pharmacy will bill patient’s insurance for the portion that patient’s insurance plan has agreed to cover. The copay savings program is not health insurance. The pharmacy, patient, or prescriber cannot submit a claim for reimbursement under any federal, state, or other governmental programs or to any third party for any part of the benefit received by the patient through the copay savings program. By using this offer, patients or their representative certify that they will comply with any terms of their health insurance contract requiring notification to their payer of the existence and/or value of this offer. The copay savings program may not be used with any other coupon, discount, prescription savings card, free trial, or other offer. It is illegal to (or offer to) sell, purchase, or trade this offer. This offer is non-transferrable. This offer is void where prohibited by law. No purchase necessary. Copay savings program benefits may not be applied retroactively. If patient’s insurance changes, the pharmacy must be notified immediately. Based on patient’s insurance change, patient may no longer be able to participate in the copay savings program. Jazz Pharmaceuticals reserves the right to terminate or modify this program at any time and without notice and in its sole discretion. In administering the copay savings program, Jazz Pharmaceuticals will process patient’s personal information in accordance with Jazz Pharmaceuticals’ Privacy Policy, which can be found at www.jazzcares.com

Hospital to Home Program

Jazz Pharmaceuticals provides a solution to ensure necessary care for patients when they have been prescribed EPIDIOLEX for outpatient use as part of their discharge from an inpatient hospital stay, the insurance reimbursement process could lead to a delay in access to therapy, and the practitioner deems that this delay in access could lead to significant negative clinical outcomes.

This program is intended solely for patients being discharged from an inpatient hospital setting^† who do not have access to EPIDIOLEX upon discharge. Patients who have a supply of EPIDIOLEX at home are not eligible for this program.

^†Eligibility requirements: Valid prescription from a licensed prescriber of EPIDIOLEX for use following discharge, legal residence in the United States (no P.O. boxes), program is permissible in the state in which the patient resides and in which the prescription is being filled.

This program is subject to change or discontinuation without notice.

Quick Start Program

Eligible* patients can get EPIDIOLEX through the Quick Start Program while coverage is being pursued. New patients may be eligible to receive up to four 15-day free supplies.

• Complete the Patient Support Program Start Form, making sure to check the two boxes at the top, sign the HCP or designated agent authorization, and obtain patient or legal guardian signature
• Fax the completed form and valid prescription to Epidiolex Engage™ at 1-855-518-7566
• Submit eRX to PharmaCord 11001 Bluegrass Parkway, Suite 200, Louisville, KY 40299
• Tell the caregiver to expect a call from the Epidiolex Engage team

*Patient eligibility:

• Patients who are 1 year of age or older with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex
• New EPIDIOLEX patients with commercial insurance as well as those who are eligible for or participate in federal healthcare programs, such as Medicaid, Medicare, or any similar federal or state programs. Patients who pay cash for their prescriptions are not eligible for the EPIDIOLEX Quick Start Program
• Program may not be applied retroactively and does not cover refills beyond the initial four 15-day supplies

Full terms and conditions
The program is good for up to four 15-day free supplies for a patient’s first-time prescription. There is a lifetime limit of one Quick Start per patient. The program is for commercially insured patients as well as beneficiaries of Medicare, Medicaid, VA or other federal or state healthcare programs. The program is for patients that have been prescribed EPIDIOLEX for an FDA-approved indication, are 1 year of age or older, are enrolled in the Epidiolex Engage Patient Support Program, and who experience a delay in obtaining coverage for EPIDIOLEX. Patients who pay cash for their prescriptions are not eligible for the EPIDIOLEX Quick Start Program. The program is only available for residents of the US and Puerto Rico. The program requires a valid, signed prescription for EPIDIOLEX for an FDA-approved indication. The program may not be submitted by the patient, pharmacy, or prescriber to seek reimbursement for all or any part of the benefit received by the patient through this program. The free supply of EPIDIOLEX cannot be used toward any out-of-pocket costs under any health insurance or prescription drug plan. The program may not be applied retroactively and does not cover refills. The program cannot be combined with any other voucher, certificate, coupon, rebate, or similar offer. Use of the program is not contingent on any purchase requirement. This is not a discount, rebate, or insurance program. The program is not valid where otherwise prohibited by law. It is illegal for any person to sell, purchase, trade, or counterfeit this offer. Jazz Pharmaceuticals reserves the right to terminate or modify this program at any time with or without notice. In order to facilitate the EPIDIOLEX Quick Start Program, you understand and agree that Jazz will process your personal information in accordance with Jazz Pharmaceuticals’ Privacy Policy, which can be found at www.jazzcares.com