Corporate Member Taiho- New Copy Program

Making Access Easier for Patients

Eligible patients may pay $0 per treatment cylce with Taiho Oncology Co-Pay Assistance Program.

To determine patient eligibility, go to TaihoOncologyCopay.com or call 844-824-4648.

If circumstances determine a patient to be significantly underinsured, then Taiho Oncology, Inc. will asssess the patient for support under the Taiho Oncology Patient Assistance Program.

You may be eligible if you:

• Have commercial prescription insurance coverage
• Use a specialty pharmacy
• Use a hospital outpatient pharmacy
• Receive your medicine from a doctor's office

You may not be eligible if you:

• Are reimbursed under Medicaid, a Medicare drug benefit program, Tricare, or other state or federal programs
• Reside outside of the US, Puerto Rico, or US territories

Restrictions and Eligibility:

Offer valid in the US, Puerto Rico, and US territories only. Only valid for patients with private insurance. Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, Tricare, or other federal or state programs (such as medical assistance programs). If the patient is eligible for drug benefits under any such program, this offer is not valid and the patient cannot use this offer. By presenting or accepting this benefit, patient and pharmacist agree not to submit claim for reimbursement under the above programs. Patient further agrees to comply with any and all terms of his or her health insurance contract requiring notification to his or her payer of the existence and/or value of this offer. It is illegal to or offer to sell, purchase, or trade this benefit. Maximum reimbursement limits apply; patient out-of-pocket expense may vary. Taiho Oncology, Inc., reserves the right to rescind, revoke, or amend this offer at any time without notice.

11/2019