STREAMLINED SUPPORT FOR YOUR PATIENTS
AND YOUR PRACTICE

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 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 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)^‡§II
• 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 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. Program covers the cost of the drug, injection administration, and injection training,^‡§II and does not cover the costs for office 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

TERMS OF USE

Denied Patient Savings Program – If FASENRA 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