Welcome to the VEOZAH Savings Program

ELIGIBILITY RESTRICTIONS, TERMS AND CONDITIONS

By enrolling in the VEOZAH Savings Program (“Program”), the patient acknowledges that they currently meet the eligibility criteria and will comply with the following terms and conditions: The Program is for eligible patients with commercial prescription insurance and is good for use only with a valid prescription for VEOZAH™ (fezolinetant) at the time the prescription is dispensed by the pharmacy. The Program has an annual maximum copay assistance limit of up to $4,000 per calendar year. After the annual maximum on copay assistance is reached, patient will be responsible for the remaining monthly out-of-pocket costs for VEOZAH. Astellas may reduce or discontinue the copay assistance available under the Program if it determines an enrolled patient does not have an approved claim for VEOZAH. Unless prohibited by law, Astellas may reduce the total copay assistance available under the Program to a maximum of $1,250 for two months (i.e., two 28–31-day fills) if it determines a VEOZAH claim for an enrolled patient is not approved by their commercial health plan. The Program is not valid for patients whose prescription claims are reimbursed, in whole or in part, by any state or federal government program, including, but not limited to, Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, Puerto Rico Government Insurance, or any state patient or pharmaceutical assistance program. Patients who move from commercial insurance to federal or state prescription health insurance will no longer be eligible, and agree to notify the Program of any such change. Patients agree not to seek reimbursement from any health insurance or third party for all or any part of the benefit received by the patient through the Program. This offer is not conditioned on any past, present, or future purchase of VEOZAH. This offer is not transferable, has no cash value, and cannot be combined with any other offer, free trial, prescription savings card, or discount (including any program offered by a third party payer or pharmacy benefit manager, or an agent of either, that adjusts patient cost-sharing obligations, through arrangements that may be referred to as “accumulator” or “maximizer” programs). The full value of the Program benefits is intended to pass entirely to the eligible patient. No other individual or entity (including, without limitation, third party payers, pharmacy benefit managers, or the agents of either) is entitled to receive any benefit, discount, or other amount in connection with this Program. This offer is not health insurance and is only valid for patients in the 50 United States, Washington DC, and Puerto Rico. This offer is not valid for cash paying patients. This Program is void where prohibited by law. No membership fees. It is illegal to sell, purchase, trade, counterfeit, duplicate, or reproduce, or offer to sell, purchase, trade, counterfeit, duplicate or reproduce the card. This offer will be accepted only at participating pharmacies. Certain rules and restrictions apply. Astellas reserves the right to revoke, rescind, or amend this offer without notice for any reason (including to ensure that the offer is utilized solely for the patient’s benefit).