PFIZER PATIENT ASSISTANCE PROGRAM ELIGIBILITY CRITERIA

• The Pfizer Patient Assistance Program is not health insurance and is available for eligible uninsured/underinsured patients only.
• Offer is only available to patients who meet financial and other criteria.
• This offer does not require, nor will it be made contingent on, purchase requirements of any kind.
• No claim for reimbursement or credit for any costs associated with the medicine(s) may be submitted to any prescription insurance provider or payer, including Medicare Part D plans.
• Pfizer reserves the right to amend, rescind, or discontinue this program at any time without notification.
• Offer good only in the US and Puerto Rico.
• Patient must be a resident of the US or Puerto Rico.
• Prescription must be provided by a healthcare provider licensed in the US or Puerto Rico.
• Patient must be treated in the outpatient setting of care.
• Additional eligibility criteria may apply. Contact XELSOURCE for details.

INTERIM CARE Rx PROGRAM TERMS & CONDITIONS

• Interim Care Rx is not health insurance and is available for eligible, commercially insured patients only.
• Offer is only available to patients who have been diagnosed with an FDA-approved indication for XELJANZ/XELJANZ XR.
• No claim for reimbursement for product dispensed pursuant to this offer may be submitted to any third-party payer.
• Not available to patients covered under government plans such as Medicaid, Medicare or other federal or state healthcare programs, including any state prescription drug assistance programs and the Government Health Insurance Plan or for residents of Massachusetts, Michigan, Minnesota, Missouri, Ohio, or Rhode Island.
• Available in 30-day supply. Refills are subject to limitations.
• Interim Care Rx offer does not require, nor will be made contingent on, purchase requirements of any kind.
• Pfizer reserves the right to amend, rescind, or discontinue this program at any time without notification.
• Interim Care Rx can only be dispensed by the exclusive pharmacy and only after benefits investigation has been completed and a delay occurs in the prior authorization or appeals process.
• Offer good only in the US and Puerto Rico.
• Prescription must be provided by a healthcare provider licensed in the US or Puerto Rico.
• Additional eligibility criteria may apply. Contact XELSOURCE for details.

VOUCHER TERMS AND CONDITIONS

By redeeming this free trial voucher you and your patient confirm that the patient meets the eligibility criteria and comply with the terms & conditions described below:

• The patient will receive a 30-day supply of XELJANZ or XELJANZ XR.
• An original voucher and a valid prescription must be presented.
• This free trial will be supplied through XELSOURCE. Massachusetts residents may select their pharmacy.
• No claim for reimbursement for product dispensed pursuant to this voucher may be submitted to any third-party payer, whether private or a government payer.
• If you participate in Medicare Part D, you must not count the value of this free product towards your True Out-of-Pocket Costs (TrOOP).
• This free trial voucher cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.
• This free trial is not health insurance.
• Offer good only in the US and Puerto Rico.
• Only new patients may use this voucher. By redeeming this voucher, physician and patient certify that the patient is not currently using XELJANZ or XELJANZ XR.
• Only 1 voucher per person may be redeemed under this program.
• This voucher is not transferable.
• Pfizer reserves the right to rescind, revoke, or amend this free trial voucher without notice.
• This free trial voucher program expires 12/31/2019.

ADDITIONAL CO-PAY SAVINGS CARD FOR ELIGIBLE COMMERCIALLY INSURED PATIENTS
TERMS & CONDITIONS

By using the Additional Co-pay Savings Card for Commercially Insured Patients (the “Card”), you acknowledge that you currently meet the eligibility criteria and will comply with the terms & conditions described below:

• The Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare, or other federal or state healthcare programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico, formerly known as “La Reforma de Salud”).
• The Card is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs which reimburse you for the entire cost of your prescription drugs.
• The Card will pay your deductible, co-payment, or co-insurance amount up to a maximum amount of $10,000 per calendar year.
• The Card may be used once per month for the life of the program.
• You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
• Cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.
• The Card will be accepted only at participating pharmacies.
• The Card is not health insurance.
• The Card is not valid where prohibited by law.
• Offer good only in the US and Puerto Rico.
• The Card is limited to 1 per person during this offering period and is not transferable.
• Pfizer reserves the right to rescind, revoke, or amend the program without notice.
• The Card and Program expire 12/31/2019.

CO-PAY CARD TERMS AND CONDITIONS

By using the XELJANZ/XELJANZ XR Co-pay Savings Card (the “Card”), you acknowledge that you currently meet the eligibility criteria and will comply with the following terms and conditions.

• Patients are not eligible to use this card if they are enrolled in a state- or federally-funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veteran Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”).
• Patient must have private insurance. Offer is not valid for cash paying patients.
• You will receive a maximum benefit of $15,000 per calendar year, which is defined by the date of enrollment through December 31st of the enrollment year, and may pay as little as $0 per month co-pay. After a maximum of $15,000, you will be responsible for paying the remaining monthly out-of-pocket costs.
• This Card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs.
• You must deduct the value of this coupon from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
• You are responsible for reporting use of the Card to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Card, as may be required. You should not use the Card if your insurer or health plan prohibits use of manufacturer Cards.
• You must be 18 years of age or older to redeem the Card.
• The Card is not valid where prohibited by law.
• The Card cannot be combined with any other savings, free trial, or similar offer for the specified prescription.
• The Card will be accepted only at participating pharmacies.
• If your pharmacy does not participate, you may be able to submit a request for a rebate in connection with this offer.
• The Card is not health insurance.
• Offer good only in the US and Puerto Rico.
• The Card is limited to 1 per person during this offering period and is not transferable.
• The Card may be used once per month for the life of the program.
• No other purchase is necessary.
• Data related to your redemption of the Card may be collected, analyzed, and shared with Pfizer, for market research and other purposes related to assessing Pfizer’s programs. Data shared with Pfizer will be aggregated and de-identified; it will be combined with data related to other Card redemptions and will not identify you.
• Pfizer reserves the right to rescind, revoke, or amend the program without notice.
• Card and Program expires 12/31/2019.

If you have questions or are in need of additional support, call 1-844-935-5269 or visit www.XELJANZ.com.

XSAVINGS MOBILE TEXT PROGRAM TERMS & CONDITIONS

User texts "XPROGRAM" to short code 50336.
Text HELP for help, STOP to opt out.
Patients may receive up to 10 messages per month.
Message and data rates may apply.

1. By opting into the XSAVINGS mobile texting program (Program), you consent to receive up to 10 text messages and/or push notifications from Pfizer Inc. Such messages may be marketing or non-marketing messages and may include co-pay related information, fill confirmation, website information, etc.
2. To stop receiving text messages, text STOP to 50336. DOING SO WILL ONLY OPT YOU OUT OF THIS PROGRAM; you will remain opted in to any other Pfizer Inc text message program(s) into which you opted separately.
3. To request more information or to obtain help, text HELP to 50336. You can also call customer service at 1-844-935-5269.
4. You represent that you are the account holder for the mobile telephone number(s) that you provide to opt into the Program. You are responsible for notifying Pfizer Inc immediately if you change your mobile telephone number. You may notify Pfizer Inc of a number change by calling 1-844-935-5269.
5. Message and data rates may apply to each text message sent or received in connection with the texting program, as provided in your mobile telephone service rate plan (please contact your mobile telephone carrier for pricing plans). Applicable roaming charges may apply. Charges are both billed and payable to your mobile service provider or deducted from your prepaid account. Pfizer Inc does not impose a separate fee for sending text messages.
6. Data obtained from you in connection with this Program may include your telephone number, your carrier's name, and details of the message (date, time, and content). Pfizer Inc may use this information to contact you and to provide the services you request.
7. For information on data collection and use, please read our full corporate Privacy Policy (https://www.pfizer.com/Privacy), which is incorporated by reference into these Terms.
8. Pfizer Inc will not be liable for any delays in the receipt of any SMS messages, as delivery is subject to effective transmission from your network operator.
9. This Program is available only on these US participating mobile carriers: Verizon Wireless, Sprint, Boost Mobile, T-Mobile, AT&T, Atlantic Tele-Network International (ATNI), Alaska Communications Systems (ACS), ASTAC, Bandwidth.com (includes Republic Wireless), Blue Wireless, Bluegrass Cellular, Breakaway Wireless, Brightlink, C Spire Wireless (aka Cellular South), Carolina West Wireless, CellCom, Cellone Nation, Cellular One of N.E. Arizona, Chariton Valley Cellular, Chat Mobility, Copper Valley Telecom, Cordova Wireless, Cross Wireless, CTC, Custer Telephone, East Kentucky Network (Appalachian Wireless), Enflick, GCI Communications, Google Voice, Illinois Valley Cellular, Inland Cellular, Inteliquent, iWireless, Leaco Rural Telephone Cooperative, Limitless Mobile, Mid-Rivers Communications, MobileNation/SI Wireless, MTA Wireless/Matanuska Kenai, Nemont CDMA, Nemont US UMTS, NewCore Wireless, Nex-Tech Wireless, NNTC Wireless, Northwest Missouri Cellular, Pine Belt Wireless, Pine Cellular, Pioneer Cellular, PTCI, Shelcomm, Silver Star PCS, Snake River PCS, SouthernLINC, SouthernLINC LTE, SRT, STRATA Networks, Standing Rock (SRTI), Thumb Cellular, Triangle Wireless, Union Wireless, U.S. Cellular, United Wireless, Viaero Wireless, Virgin Mobile, West Central Wireless.
10. You agree to indemnify Pfizer Inc and any third parties texting on its behalf in full for all claims, expenses, and damages related to or caused, in whole or in part, by your failure to immediately notify us if you change your telephone number, including but not limited to all claims, expenses, and damages related to or arising under the Telephone Consumer Protection Act.
11. Pfizer Inc may immediately suspend or terminate your participation in the Program if it believes you are in breach of these SMS Terms and Conditions. Your participation in this Program is also subject to termination in the event that your mobile telephone service terminates or lapses. Pfizer Inc reserves the right to modify or discontinue, temporarily or permanently, all or any part of the Program, with or without notice.
12. Pfizer Inc may revise, modify, or amend these SMS Terms and Conditions at any time. Any such revision, modification, or amendment shall take effect when it is posted to Pfizer Inc's website. You agree to review these SMS Terms and Conditions periodically to ensure that you are aware of any changes. Your continued consent to receive text messages will indicate your acceptance of those changes.