The EPIDIOLEX^® Copay
Savings 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