Terms and Conditions

Copay Savings Program

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-transferable. 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.

Quick Start Program

The program is good for up to four 15-day free supplies for a patient’s first-time prescription. There is a lifetime limit of one Quick Start per patient. The program is for commercially insured patients as well as beneficiaries of Medicare, Medicaid, VA or other federal or state healthcare programs. The program is for patients who have been prescribed EPIDIOLEX for an FDA-approved indication, are 1 year of age or older, are enrolled in the JazzCares Patient Support Program, and who experience a delay in obtaining coverage for EPIDIOLEX. Patients who pay cash for their prescriptions are not eligible for the EPIDIOLEX Quick Start Program. The program is only available for residents of the US and Puerto Rico. The program requires a valid, signed prescription for EPIDIOLEX for an FDA-approved indication. The program may not be submitted by the patient, pharmacy, or prescriber to seek reimbursement for all or any part of the benefit received by the patient through this program. The free supply of EPIDIOLEX cannot be used toward any out-of-pocket costs under any health insurance or prescription drug plan. The program may not be applied retroactively and does not cover refills. The program cannot be combined with any other voucher, certificate, coupon, rebate, or similar offer. Use of the program is not contingent on any purchase requirement. This is not a discount, rebate, or insurance program. The program is not valid where otherwise prohibited by law. It is illegal for any person to sell, purchase, trade, or counterfeit this offer. Jazz Pharmaceuticals reserves the right to terminate or modify this program at any time with or without notice. In order to facilitate the EPIDIOLEX Quick Start Program, you understand and agree that Jazz will process your personal information in accordance with Jazz Pharmaceuticals’ Privacy Policy, which can be found at www.jazzcares.com.

Hospital to Home Program

Eligibility requirements: Valid prescription from a licensed prescriber of EPIDIOLEX for use following discharge, legal residence in the United States (no P.O. boxes), program is permissible in the state in which the patient resides and in which the prescription is being filled.

This program is subject to change or discontinuation without notice.

Patient Assistance Program

Terms and Conditions apply.