Access Support Options

ELIGIBILITY

Patients must have commercial health insurance that covers medication costs for CALQUENCE but not the full cost to the patient. Patients are ineligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE, or where prohibited by law. Eligibility rules apply. Additional restrictions may apply. If the patient is enrolled in a state or federally-funded prescription insurance program, he or she may not use this program even if he or she elects to be processed as an uninsured (cash-paying) patient. This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

TERMS OF USE

Eligible patients with an activated co-pay card and a valid prescription may pay as little as $0 per 30-day supply; monthly, annual, and/or per-claim maximum program benefits may apply and may vary from patient to patient, depending on the terms of a patient’s prescription drug plan and to ensure that the funds are used for the benefit of the patient, as solely based on factors determined solely by AstraZeneca.

Some prescription drug plans have established programs referred to as ‘co-pay maximizer’ or ‘co-pay accumulator’ programs. Co-pay maximizer and co-pay accumulator programs are ones in which the amount of the patient’s out-of-pocket costs is adjusted to reflect the availability of support offered by a co-pay support program. Patients enrolled in co-pay maximizer or co-pay accumulator programs may receive varied program benefits to ensure the program funds are used for the benefit of the patient.

AstraZeneca will monitor program utilization data and reserves the right to vary or discontinue program benefits at any time if AstraZeneca determines that patients are subject to a co-pay maximizer or co-pay accumulator program. Any potential program re-enrollment may be subject to similar program restrictions based on patient’s prescription drug plan.

Other restrictions may apply. Patient is responsible for applicable taxes, if any. Patient must be enrolled in the program before use. If you have any questions regarding this offer, please call 1-844-ASK-A360 (1-844-275-2360).

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills.

Offer is invalid for claims or transactions more than 365 days from the date of service. A valid prescription must accompany Patient Savings Program offer.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

ELIGIBILITY

Patients must have commercial health insurance that covers medication costs for FASLODEX, but not the full cost to the patient.

Patients are ineligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TriCare, or where prohibited by law. Eligibility rules apply. Additional restrictions may apply.

If the patient is enrolled in a state or federally funded prescription insurance program, he or she may not use this program even if he or she elects to be processed as an uninsured (cash paying) patient.

This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

TERMS OF USE

Patient is responsible for applicable taxes, if any. Patient must be enrolled in the program before use. If you have any questions regarding this offer, please call 1-844-ASK-A360 (1-844-275-2360). Other restrictions may apply.

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility and terms of use at any time without notice. This offer is not conditioned on any past, present or future purchase, including refills. Offer must be presented along with a valid prescription at the time of purchase.

Patients must have commercial health insurance that covers medication costs for the prescribed product, but not the full cost to the patient.

The program does not cover costs associated with a patient visit including prescriber, staff, or administrative charges associated with administering the applicable AstraZeneca product.

A valid prescription must accompany patient savings program offer.

Offer is invalid for claims or transactions more than 120 days from the date of service.

BY USING THIS PROGRAM, YOU UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

ELIGIBILITY

Patients must have commercial health insurance that covers medication costs for  IMJUDO but not the full cost to the patient. Patients are ineligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE, or where prohibited by law. Eligibility rules apply. Additional restrictions may apply. If the patient is enrolled in a state or federally-funded prescription insurance program, he or she may not use this program even if he or she elects to be processed as an uninsured (cash-paying) patient. This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

TERMS OF USE

Eligible patients with an activated co-pay card and a valid prescription may pay as little as $0 per 30-day supply; monthly, annual, and/or per-claim maximum program benefits may apply and may vary from patient to patient, depending on the terms of a patient’s prescription drug plan and to ensure that the funds are used for the benefit of the patient, as solely based on factors determined solely by AstraZeneca.

Some prescription drug plans have established programs referred to as ‘co-pay maximizer’ or ‘co-pay accumulator’ programs. Co-pay maximizer and co-pay accumulator programs are ones in which the amount of the patient’s out-of-pocket costs is adjusted to reflect the availability of support offered by a co-pay support program. Patients enrolled in co-pay maximizer or co-pay accumulator programs may receive varied program benefits to ensure the program funds are used for the benefit of the patient.

AstraZeneca will monitor program utilization data and reserves the right to vary or discontinue program benefits at any time if AstraZeneca determines that patients are subject to a co-pay maximizer or co-pay accumulator program. Any potential program re-enrollment may be subject to similar program restrictions based on patient’s prescription drug plan.

Other restrictions may apply. Patient is responsible for applicable taxes, if any. Patient must be enrolled in the program before use. If you have any questions regarding this offer, please call 1-844-ASK-A360 (1-844-275-2360).

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills.

Offer is invalid for claims or transactions more than 365 days from the date of service. A valid prescription must accompany Patient Savings Program offer.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

ELIGIBILITY

Patients must have commercial health insurance that covers medication costs for IMFINZI and/or IMJUDO but not the full cost to the patient. Patients are ineligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE, or where prohibited by law. Eligibility rules apply. Additional restrictions may apply. If the patient is enrolled in a state or federally-funded prescription insurance program, he or she may not use this program even if he or she elects to be processed as an uninsured (cash-paying) patient. This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

TERMS OF USE

Eligible patients with an activated co-pay card and a valid prescription may pay as little as $0 per 30-day supply; monthly, annual, and/or per-claim maximum program benefits may apply and may vary from patient to patient, depending on the terms of a patient’s prescription drug plan and to ensure that the funds are used for the benefit of the patient, as solely based on factors determined solely by AstraZeneca. Some prescription drug plans have established programs referred to as ‘co-pay maximizer’ or ‘co-pay accumulator’ programs. Co-pay maximizer and co-pay accumulator programs are ones in which the amount of the patient’s out-of-pocket costs is adjusted to reflect the availability of support offered by a co-pay support program. Patients enrolled in co-pay maximizer or co-pay accumulator programs may receive varied program benefits to ensure the program funds are used for the benefit of the patient.

AstraZeneca will monitor program utilization data and reserves the right to vary or discontinue program benefits at any time if AstraZeneca determines that patients are subject to a co-pay maximizer or co-pay accumulator program. Any potential program re-enrollment may be subject to similar program restrictions based on patient’s prescription drug plan.

Other restrictions may apply. Patient is responsible for applicable taxes, if any. Patient must be enrolled in the program before use. If you have any questions regarding this offer, please call 1-844-ASK-A360 (1-844-275-2360).

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills.

Program covers the cost of the drug and administration (program maximum of $100 per infusion assistance), but does not cover costs for office visits or any other associated costs.^*,†

Offer is invalid for claims or transactions more than 365 days from the date of service. A valid prescription must accompany Patient Savings Program offer.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

ELIGIBILITY

You may be eligible for this offer if you are insured by commercial insurance.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part B, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If you are enrolled in a state or federally funded prescription insurance program, you may not use this program even if you elect to be processed as an uninsured (cash paying) patient.

This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

TERMS OF USE

Eligible commercially insured patients with a valid prescription for FASENRA who enroll in this program may pay as little as $0 per administration of FASENRA dependent upon patient’s prescription coverage of FASENRA.

If FASENRA is covered by the health plan:

• Up to $13,000 per calendar year in assistance for out-of-pocket expenses

If FASENRA is NOT covered by the health plan:

• Prescription fills for 24 months from the date of the initial prescription
• A PA Denial and PA Appeal Denial by your health plan are required to be eligible for this program
• FASENRA must be prescribed for on label use to be eligible for this program
• This program is only administered by approved specialty pharmacies

The out-of-pocket costs covered by the program can include the cost of the product itself and the cost of injection administration of the product (program maximum of $100 per injection administration)^*† Other restrictions may apply. Patient must be enrolled in the program before use. If you have any questions regarding the offer, please call 1-833-360-HELP (1-833-360-4357).

Offer is invalid for claims or transactions more than 365 days from the date of service.

Non-transferable, limited to one person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for FASENRA at the time of purchase.

Patients must have commercial health insurance.

Program covers the cost of the drug and administration, and does not cover the costs for office visits or any other associated costs.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

ELIGIBILITY:

Patients may be eligible for this offer with the following criteria:

• Insured by Commercial insurance with a valid prescription for SAPHNELO^® (anifrolumab-fnia) injection for Intravenous infusion, 300 mg AND
• Are a resident of the United States or Puerto Rico AND
• Are not enrolled in a government funded program

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients who are enrolled in Medicare Part B, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. Patients who are enrolled in a state or federally funded prescription program may not use this program even if they elect to be processed as uninsured (cash-paying). This offer is not insurance.

TERMS OF USE:

Eligible commercially insured patients with a valid prescription for SAPHNELO who enroll in this program may pay as little as $0 per administration of SAPHNELO dependent upon patient’s prescription coverage of SAPHNELO.

SAPHNELO Savings Program – If SAPHNELO is covered by the health plan:

• Up to $16,500 per calendar year in assistance for out-of-pocket expenses
• The out-of-pocket costs covered by the program can include the cost of the product itself, the cost of infusion administration (program maximum of $150 per infusion administration).^*†
• Other restrictions may apply. Patient must be enrolled in the program before use. If you have any questions regarding the offer, please call 1-866-SAPHNELO (1-866-727-4635).
• Offer is invalid for claims or transactions more than 365 days from the date of service.

Other restrictions apply. Patient is responsible for applicable taxes, if any. Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for SAPHNELO at the time of purchase. Program covers the cost of the drug, infusion administration,^*† and does not cover the costs for office visits or any other associated costs.

If you meet the Copay Savings program eligibility criteria but SAPHNELO is not covered by your health plan, you may qualify for the Denied Patient Savings Program.

Denied Patient Savings Program Eligibility: Patient must meet all savings program eligibility criteria in addition to the following criteria:

• A Prior Authorization denial and Prior Authorization appeal denial by your health plan are required
• SAPHNELO must be prescribed for on-label use

TERMS OF USE:

Denied Patient Savings Program – If SAPHNELO is NOT covered by the health plan:

• Prescription fills for up to 24 months from the date of the initial prescription
• This program is only administered by approved specialty pharmacies
• Program support includes periodic Benefits Investigation to identify potential changes in patient coverage. If a change in coverage is identified, the prescriber will be contacted to initiate a new Prior Authorization for the patient. If the Prior Authorization is approved, the patient will transition to coverage via their insurance benefits

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

ELIGIBILITY

Patients must have commercial health insurance that covers medication costs for ETCAMAH but not the full cost to the patient. Patients are ineligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE, or where prohibited by law. Eligibility rules apply. Additional restrictions may apply. If the patient is enrolled in a state or federally-funded prescription insurance program, he or she may not use this program even if he or she elects to be processed as an uninsured (cash-paying) patient. This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

TERMS OF USE

Eligible patients with an activated co-pay card and a valid prescription may pay as little as $0 per 30-day supply; monthly, and annual, and/or per-claim maximum program benefits may apply and may vary from patient to patient, depending on the terms of a patient’s prescription drug plan and to ensure that the funds are used for the benefit of the patient, as solely based on factors determined solely by AstraZeneca.

Some prescription drug plans have established programs referred to as ‘co-pay maximizer’ or ‘co-pay accumulator’ programs. Co-pay maximizer and co-pay accumulator programs are ones in which the amount of the patient’s out-of-pocket costs is adjusted to reflect the availability of support offered by a co-pay support program. Patients enrolled in co-pay maximizer or co-pay accumulator programs may receive varied program benefits to ensure the program funds are used for the benefit of the patient.

AstraZeneca will monitor program utilization data and reserves the right to vary or discontinue program benefits at any time if AstraZeneca determines that patients are subject to a co-pay maximizer or co-pay accumulator program. Any potential program re-enrollment may be subject to similar program restrictions based on patient’s prescription drug plan.

Other restrictions may apply. Patient is responsible for applicable taxes, if any. Patient must be enrolled in the program before use. If you have any questions regarding this offer, please call 1-844-ASK-A360 (1-844-275-2360).

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills.

Offer is invalid for claims or transactions more than 365 days from the date of service. A valid prescription must accompany Patient Savings Program offer.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE. 

ELIGIBILITY

Patients must have commercial health insurance that covers medication costs for TRUQAP but not the full cost to the patient. Patients are ineligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE, or where prohibited by law. Eligibility rules apply. Additional restrictions may apply. If the patient is enrolled in a state or federally-funded prescription insurance program, he or she may not use this program even if he or she elects to be processed as an uninsured (cash-paying) patient. This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

TERMS OF USE

Eligible patients with an activated co-pay card and a valid prescription may pay as little as $0 per 30-day supply; monthly, and annual, and/or per-claim maximum program benefits may apply and may vary from patient to patient, depending on the terms of a patient’s prescription drug plan and to ensure that the funds are used for the benefit of the patient, as solely based on factors determined solely by AstraZeneca.

Some prescription drug plans have established programs referred to as ‘co-pay maximizer’ or ‘co-pay accumulator’ programs. Co-pay maximizer and co-pay accumulator programs are ones in which the amount of the patient’s out-of-pocket costs is adjusted to reflect the availability of support offered by a co-pay support program. Patients enrolled in co-pay maximizer or co-pay accumulator programs may receive varied program benefits to ensure the program funds are used for the benefit of the patient.

AstraZeneca will monitor program utilization data and reserves the right to vary or discontinue program benefits at any time if AstraZeneca determines that patients are subject to a co-pay maximizer or co-pay accumulator program. Any potential program re-enrollment may be subject to similar program restrictions based on patient’s prescription drug plan.

Other restrictions may apply. Patient is responsible for applicable taxes, if any. Patient must be enrolled in the program before use. If you have any questions regarding this offer, please call 1-844-ASK-A360 (1-844-275-2360).

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills.

Offer is invalid for claims or transactions more than 365 days from the date of service. A valid prescription must accompany Patient Savings Program offer.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

ELIGIBILITY

You may be eligible for this offer with the following criteria:

• You have a valid prescription for WAINUA ^TM (eplontersen) AND
• Insured by commercial insurance and your insurance covers your prescription AND
• A resident of the United States or Puerto Rico AND
• Enrolled in the WAINUA Savings Program AND
• Are not enrolled in a government-funded program

Patients who are enrolled in a state- or federally funded insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TRICARE, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver plan or government-subsidized prescription drug benefit program for retirees. If you are enrolled in a state- or federally funded prescription insurance program, you are not eligible to use this Savings Program even if you elect to be processed as an uninsured (cash-paying) patient.

TERMS OF USE

• Patient must be enrolled in the WAINUA Savings Program before use
• If you have any questions regarding the offer, please call WAINUA Way Support 1-844-2-WAINUA (1-844-292-4682)
• Offer is invalid for claims or transactions more than 365 days from the date of service

Other restrictions may apply. Patient is responsible for applicable taxes, if any. Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer, including flexible spending account or healthcare savings account.

Maximum Savings Limit, Total Program Benefit, Benefits May Change, End or Vary: The program provides up to a Maximum Savings Limit of assistance to reduce a patient’s out-of-pocket medication costs that AstraZeneca will provide per patient for each calendar year, which must be applied to the patient’s out-of-pocket costs (co-pay, deductible, or co-insurance). Total Program Benefit amounts are unilaterally determined by AstraZeneca in its sole discretion and will not exceed the Maximum Savings Limit. The Total Program Benefit may be less than the Maximum Savings Limit, depending on the terms of a patient’s plan, and may vary among individual patients covered by different plans, based on factors determined solely by AstraZeneca, to ensure all programs funds are used for the benefit of the patient. Each patient is responsible for costs above the Patient Total Program Benefit amounts.

Some prescription drug plans have established programs referred to as ‘co-pay maximizer’ or ‘co-pay accumulator’ programs. Co-pay maximizer and co-pay accumulator programs are ones in which the amount of the patient’s out-of-pocket costs is adjusted to reflect the availability of support offered by a co-pay support program. Patients enrolled in co-pay maximizer or co-pay accumulator programs may receive varied program benefits to ensure the program funds are used for the benefit of the patient.

AstraZeneca will monitor program utilization data and reserves the right to vary or discontinue program benefits at any time if AstraZeneca determines that patients are subject to a co-pay maximizer or co-pay accumulator program. Any potential program re-enrollment may be subject to similar program restrictions based on patient’s prescription drug plan.

AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription at the time of purchase. The out-of-pocket costs covered by the program can include the cost of the product does not cover the costs for office visits or any other associated costs.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

ELIGIBILITY

Patients must have commercial health insurance that covers medication costs for TAGRISSO but not the full cost to the patient. Patients are ineligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE, or where prohibited by law. Eligibility rules apply. Additional restrictions may apply. If the patient is enrolled in a state or federally-funded prescription insurance program, he or she may not use this program even if he or she elects to be processed as an uninsured (cash-paying) patient. This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

TERMS OF USE

Eligible patients with an activated co-pay card and a valid prescription may pay as little as $0 per 30-day supply; monthly, annual, and/or per-claim maximum program benefits may apply and may vary from patient to patient, depending on the terms of a patient’s prescription drug plan and to ensure that the funds are used for the benefit of the patient, as solely based on factors determined solely by AstraZeneca.

Some prescription drug plans have established programs referred to as ‘co-pay maximizer’ or ‘co-pay accumulator’ programs. Co-pay maximizer and co-pay accumulator programs are ones in which the amount of the patient’s out-of-pocket costs is adjusted to reflect the availability of support offered by a co-pay support program. Patients enrolled in co-pay maximizer or co-pay accumulator programs may receive varied program benefits to ensure the program funds are used for the benefit of the patient.

AstraZeneca will monitor program utilization data and reserves the right to vary or discontinue program benefits at any time if AstraZeneca determines that patients are subject to a co-pay maximizer or co-pay accumulator program. Any potential program re-enrollment may be subject to similar program restrictions based on patient’s prescription drug plan.

Other restrictions may apply. Patient is responsible for applicable taxes, if any. Patient must be enrolled in the program before use. If you have any questions regarding this offer, please call 1-844-ASK-A360(1-844-275-2360).

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills.

Offer is invalid for claims or transactions more than 365 days from the date of service. A valid prescription must accompany Patient Savings Program offer.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

ELIGIBILITY

Patients must have commercial health insurance that covers medication costs for LYNPARZA but not the full cost to the patient. Patients are ineligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE, or where prohibited by law. Eligibility rules apply. Additional restrictions may apply. If the patient is enrolled in a state or federally-funded prescription insurance program, he or she may not use this program even if he or she elects to be processed as an uninsured (cash-paying) patient. This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

TERMS OF USE

Eligible patients with an activated co-pay card and a valid prescription may pay as little as $0 per 30-day supply; monthly, annual, and/or per-claim maximum program benefits may apply and may vary from patient to patient, depending on the terms of a patient’s prescription drug plan and to ensure that the funds are used for the benefit of the patient, as solely based on factors determined solely by AstraZeneca.

Some prescription drug plans have established programs referred to as ‘co-pay maximizer’ or ‘co-pay accumulator’ programs. Co-pay maximizer and co-pay accumulator programs are ones in which the amount of the patient’s out-of-pocket costs is adjusted to reflect the availability of support offered by a co-pay support program. Patients enrolled in co-pay maximizer or co-pay accumulator programs may receive varied program benefits to ensure the program funds are used for the benefit of the patient.

AstraZeneca will monitor program utilization data and reserves the right to vary or discontinue program benefits at any time if AstraZeneca determines that patients are subject to a co-pay maximizer or co-pay accumulator program. Any potential program re-enrollment may be subject to similar program restrictions based on patient’s prescription drug plan.

Other restrictions may apply. Patient is responsible for applicable taxes, if any. Patient must be enrolled in the program before use. If you have any questions regarding this offer, please call 1-844-ASK-A360 (1-844-275-2360).

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills.

Offer is invalid for claims or transactions more than 365 days from the date of service. A valid prescription must accompany Patient Savings Program offer.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.