Pay as Little as $0 for FASENRA

Cost should not get in the way

of starting and staying on your

treatment. If you have commercial

insurance,

you may pay as

little as $0 for FASENRA and its

injection administration.

†‡§

Pay as Little as $0 for FASENRA

If you’re without prescription coverage or can’t afford your

medication, AstraZeneca may be able to help. Please visit

https://www.astrazeneca-us.com/medicines/Affordability.html

for more information.

See page 2 for more details on how to

enroll in the FASENRA Savings Program.

*Commercial health insurance, or private health insurance, is any insurance that is not paid for by the government.

Examples of government-paid insurance are Medicare and Medicaid.

†

Patients with commercial health insurance receive up to $13,000 per calendar year in assistance for out-of-pocket expenses.

See back cover for full Eligibility and Terms of Use.

‡

Patients who are residents of Massachusetts or Rhode Island are not eligible for injection administration assistance.

Patients who are residents of Massachusetts, Michigan, Minnesota, or Rhode Island are not eligible for injection training

assistance.

co-pay

for Fasenra

To enroll in the FASENRA Savings Program:

• Visit www.Fasenra.com

• Call AstraZeneca FASENRA 360 at 1-833-360-HELP (4357), or

• Ask your doctor or your doctor’s ofce staff to enroll you

co-pay

for Fasenra

Act Now to Pay as Little as $0 for Your FASENRA

If eligible, you can save on your co-pay costs by enrolling in

the FASENRA Savings Program.

Enrolling is easy:

Visit www.Fasenra.com

Call AstraZeneca FASENRA 360 at

1-833-360-HELP (4357)

Ask your doctor or your doctor’s ofﬁce staff

to enroll you

Additionally, ask your specialty

pharmacy to make sure you’re

enrolled in co-pay savings

Personalized Support When You Want It

If you are denied coverage to FASENRA, we may be able to help

FASENRA

can provide up to two years of free product to eligible

patients who were denied coverage by their insurance company.

Eligibility requirements include*:

• New to FASENRA

• Prescribed FASENRA for an FDA-approved use

Ask your doctor to contact AstraZeneca if you get a denial letter from

your insurance company - Your doctor will have to send information

to AstraZeneca to qualify you for this program

To learn more about FASENRA 360:

• Call 1-833-360-HELP (4357) Monday–Friday, 8:00 am to 8:00 pm ET

* Full details included in terms of use section on following page

For more information about FASENRA,

visit www.FASENRA.com.

FASENRA is a registered trademark and AstraZeneca FASENRA 360 is a trademark of the AstraZeneca group of companies.

Eligibility

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

• Insured by Commercial insurance with a valid prescription for FASENRA

(benralizumab) subcutaneous injection,

30 mg AND

• Are a resident of the United States or US Territories 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 benet 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.

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.

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

• Up to $13,000 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 injection

administration, and injection training of the product (program maximum of $100 per injection administration or

injection training)*

,†,§

• 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

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 benet 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

rells. Offer must be presented along with a valid prescription for FASENRA at the time of purchase. Program covers

the cost of the drug, injection administration, and injection training,*

,†, §

and does not cover the costs for ofce visits or

any other associated costs.

If you meet the Copay Savings program eligibility criteria but FASENRA 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

• FASENRA must be prescribed for on-label use

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

• Prescription lls 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 Benets Investigation to identify potential changes in patient coverage. If a

change in coverage is identied, 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 benets

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO

COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

* Patients are responsible for any cost associated with the injection administration or injection training above the $100 per injection

administration and injection training assistance provided by the program.

†

Patients who are residents of Massachusetts or Rhode Island are not eligible for injection administration assistance.

Patients who are residents of Massachusetts, Michigan, Minnesota, or Rhode Island are not eligible for injection training assistance.