Otezla is the first and only FDA-approved pill for oral ulcers associated with Behçet’s Disease

Otezla® Co-Pay Card Terms and Conditions

I. ELIGIBILITY

Eligibility Criteria: Subject to program limitations and terms and conditions, the Otezla Co-Pay Card is open to patients who have an Otezla prescription and who have commercial or private insurance, including plans available through state and federal healthcare exchanges. This program helps eligible patients cover out-of-pocket costs related to Otezla, up to program limits. There is no income requirement to participate in this program.

This offer is not valid for patients whose Otezla prescription is paid for in whole or in part by Medicare, Medicaid, or any other federal or state programs. It is not valid for cash-paying patients or where prohibited by law. A patient is considered cash-paying where the patient has no insurance coverage for Otezla or where the patient has commercial or private insurance but Amgen in its sole discretion determines the patient is effectively uninsured because such coverage does not provide a material level of financial assistance for the cost of an Otezla prescription.

II. PROGRAM BENEFITS

The Otezla Co-Pay Card helps provide out-of-pocket support to eligible patients for their Otezla prescription up to program limits. With the Otezla Co-Pay Card, a commercially insured patient who meets eligibility criteria can receive one of two offers when filling their Otezla prescription: the Bridge Offer or the Co-Pay Card Offer. Patients can participate in one offer at a time. See PROGRAM DETAILS for full description.

The Otezla Co-Pay Card offer does not cover out-of-pocket costs for any patient whose selected coverage option under their commercial insurance plan does not apply Otezla Co-Pay Card payments to satisfy the patient’s co-payment, deductible, or co-insurance for Otezla. Patients with these plan limitations are not eligible for the Otezla Co-Pay Card but may be eligible for other needs-based assistance provided by Amgen. These programs are often referred to as accumulator adjustment programs. If you believe your commercial insurance plan may have such limitations, please contact Otezla SupportPlus at 1-844-4OTEZLA (1-844-468-3952).

The Otezla Co-Pay Card also may provide a reduced benefit amount, unilaterally determined by Amgen in its sole discretion, to satisfy the out-of-pocket cost-sharing requirement for any patient whose plan or plan agent (including, but not limited to, a Pharmacy Benefit Manager [PBM]) requires enrollment in the Otezla Co-Pay Card as a condition of the plan or PBM waiving some or all of an otherwise applicable patient out-of-pocket cost-sharing amount. These programs are often referred to as co-pay maximizer programs. If you believe your commercial insurance plan may have such limitations, please contact Otezla SupportPlus at 1-844-4OTEZLA (1-844-468-3952). Health plans, specialty pharmacies, and Pharmacy Benefit Managers (individually and collectively “Plan Administrators”) are prohibited from enrolling patients in the Otezla Co-Pay Card. Plan Administrators are prohibited from assisting patients with enrollment in the Otezla Co-Pay Card. The patient, or his/her legal representative, must personally enroll in the Otezla Co-Pay in order to be eligible for program benefits.

If at any time a patient begins receiving prescription drug coverage under any state or government program (including but not limited to Medicare, Medicaid, TRICARE, Department of Defense, or Veteran Affairs programs), the patient will no longer be able to use this card and they must contact Otezla SupportPlus at 1-844-4OTEZLA (1-844-468-3952) (Monday through Friday, from 8AM-8PM ET) to stop their participation in this program.

Patients may not seek reimbursement for the value received from the Otezla Co-Pay Card from any third-party payers, including a flexible spending account or healthcare savings account. Participating in this program means that you are ensuring you comply with any required disclosure regarding your participation in the Otezla Co-Pay Card of your insurance carrier or Pharmacy Benefit Manager. Restrictions may apply. Offer is subject to change or discontinuation without notice. This is not health insurance.

III. PROGRAM DETAILS

With the Otezla Co-Pay Card, a commercially insured patient who meets eligibility criteria can receive one of the following two offers when filling their Otezla prescription:

Bridge to Commercial Coverage Offer

• If the patient’s health plan does not cover Otezla (apremilast) or requires a prior authorization, a patient can receive Otezla free for up to 3 prescription fills over 90 days (whichever occurs first) from the date of the first prescription filled under the Bridge Offer, while pursuing approval from their health plan.

Co-Pay Offer

• If Otezla is approved by the patient’s health plan, a patient can pay as little as a $0 co-pay per month for their Otezla monthly out-of-pocket costs.
• For all eligible patients, the Otezla Co-Pay Card offers:
  • A program benefit that covers the patient’s eligible out-of-pocket prescription costs for Otezla (co-pay, deductible, or co-insurance) on behalf of the patient, up to a Maximum Program Benefit determined by the program per calendar year.
  • Otezla patients can pay $0 out of pocket at the first fill and at every refill, and Amgen will pay on behalf of the patient the remaining eligible out-of-pocket prescription costs (up to the Patient Total Program Benefit described below; Otezla patients are responsible for all amounts that exceed this limit).
• Maximum Program Benefit, Patient Total Program Benefit and Benefits May Change, End, or Vary: The program provides up to a Maximum Program Benefit of assistance to reduce a patient’s out-of-pocket prescription costs that Amgen will provide per patient for each calendar year, which must be applied to the Otezla patient’s out-of-pocket costs (co-pay, deductible, or co-insurance). Patient Total Program Benefit amounts are unilaterally determined by Amgen in its sole discretion and will not exceed the Maximum Program Benefit. The Patient Total Program Benefit may be less than the Maximum Program Benefit, depending on the terms of a patient’s prescription drug plan, and may vary among individual patients covered by different plans, based on factors determined solely by Amgen, 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. Please ask your Otezla SupportPlus representative to help you understand whether your particular insurance coverage is likely to result in your reaching the Maximum Program Benefit or your Patient Total Program Benefit amount by calling 1-844-4OTEZLA (1-844-468-3952) and selecting option 1. Participating patients are solely responsible for updating Amgen with changes to their prescription health insurance including, but not limited to, initiation of insurance provided by the government, the addition of any coverage terms that do not apply Otezla Co-Pay Card benefits to reduce a patient’s out-of-pocket costs, such as accumulator adjustment benefit design or a co-pay maximization program. Participating patients are responsible for providing Amgen with accurate information necessary to determine program eligibility. By accepting payments from Amgen made on behalf of participating patients, participating PBMs and Plans likewise are responsible for providing Amgen with accurate information regarding patient eligibility.
• Patients may use the card every time they fill their Otezla prescription. Benefits reset each calendar year. Enrollment in the program is for 12 months. Patients may participate in the program for 12 months, or continue in the program after that, provided s/he continues to meet all of the program’s eligibility requirements during participation in the program, and with program enrollment renewal every 12 months. Patients can enroll/re-enroll by calling 1-844-4OTEZLA (1-844-468-3952).