SAVE ON APTIOM

Aptiom^® (eslicarbazepine acetate) Voucher Program Terms and Conditions

• You must be 18 years of age or older to accept this offer. This offer is valid only for eligible patients and legal guardians of eligible patients. Patients must have a valid prescription for APTIOM within APTIOM’s approved indication(s)
• This voucher is valid for a prescription of APTIOM
• Limit 1 voucher per patient per lifetime
• No purchase necessary. Refills are not required
• This voucher is not transferable. No substitutions are permitted. This offer cannot be combined with any other free trial, coupon, discount, prescription savings card, or other offer
• This voucher is not health insurance. Claim shall not be submitted to any public or private third-party payer or any federal or state health care program for reimbursement
• Offer valid only in the United States and Puerto Rico. Void where prohibited by law, taxed, or restricted
• It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit this voucher. Void if reproduced
• Certain information related to your use of the Voucher may be collected, analyzed, and shared with Sunovion for market research and other purposes related to assess Sunovion's programs. Information shared with Sunovion will be aggregated and deidentified; it will be combined with other data related to other Voucher redemptions and will not identify you
• Sunovion reserves the right to rescind, revoke, or amend this offer at any time without notice

To the Patient: Present this voucher to the pharmacist at a participating pharmacy, along with your valid prescription from a health care professional. Limitations apply. Please see Terms and Conditions. Need help? Call 1.800.657.7613 (8 AM–8 PM, Monday–Friday).

To the Pharmacist: Must be accompanied by a valid prescription for APTIOM. Prescriber ID# required on prescription. Dispense as written with no cost to the patient. For reimbursement, submit claim to McKesson Corporation using BIN #610524. Do not submit to any other payer, public or private, for reimbursement. For pharmacy processing questions, please call the McKesson Help Desk at 1.800.657.7613 (8 AM–8 PM, Monday–Friday).

For a Patient with Commercial Insurance: For reimbursement, please submit claim to the primary Third Party Payer first. Submit remaining balance to McKesson Corporation. The remaining balance will be reduced to $0 and you will receive this in your reimbursement from McKesson Corporation.

For all other Patients (Cash or Government Insured – Medicare, Medicaid, VA, DOD, or TriCARE): For reimbursement, please submit entire amount to McKesson Corporation using Bin #610524. Do not submit to any other payer, public or private, for reimbursement.

For pharmacy processing questions, please call the McKesson Help Desk at 1.800.657.7613 (8 AM–8 PM, Monday–Friday).

TrialScript is a registered trademark of McKesson Corporation.

Aptiom^® (eslicarbazepine acetate) High-Deductible Discount Card Program Terms and Conditions

• This offer is valid only for eligible patients 18 years of age or older, or legal guardians of patients between 4 and 17 years of age with a valid prescription for APTIOM within APTIOM's approved indication(s)
• Offer limited to one per person and may not be used with any other offer for APTIOM
• High-deductible commercial insurance required
• Cash-paying patients are not eligible
• Offer not valid if prescriptions are paid in part or full by any state or federally funded health care programs, including but not limited to Medicare, Medicaid, Medigap, VA, DOD, TRICARE, or where prohibited by law
• Activation is required to use this card
• Offer allows for savings on out-of-pocket costs greater than $35 per prescription fill, with a maximum benefit up to $500 each for three 30-day prescription fills. Individual amounts may vary
• For patients using this card for a 90-day prescription fill, this card may only be used one time for up to $1500 maximum benefit
• This program is not health insurance. The amount of the benefit cannot exceed the patient’s out-of-pocket expenses. Acceptance of this offer must be consistent with the terms of any drug benefit provided by a health insurer, health plan, or other third-party payer. If requested or required by any such payer, the patient must report the use of this card. The patient must deduct the value of the savings received under this program from any reimbursement request submitted to the patient’s insurance plan, either directly or on the patient’s behalf
• For California and Massachusetts residents, benefits pursuant to this card will terminate automatically upon the introduction of a therapeutically equivalent product
• Certain information related to your use of the High-Deductible Discount Card may be collected, analyzed, and shared with Sunovion for market research and other purposes related to assess Sunovion's programs. Information shared with Sunovion will be aggregated and deidentified; it will be combined with other data related to other High-Deductible Discount Card redemptions and will not identify you
• Offer valid only in the United States and Puerto Rico. Void where prohibited by law, taxed, or restricted

Sunovion reserves the right to rescind, revoke, or amend this offer at any time without notice. This offer is not transferable and may not be sold, purchased, or traded, or offered for sale, purchase, or trade.

To the Patient: You must present this card to the pharmacist along with your APTIOM prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the APTIOM High-Deductible Discount Card program at 1.855.820.0071 from 8 AM to 8 PM ET, Monday through Friday. When you use this card, you are certifying that you have read the program rules, regulations, and terms and conditions; you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription; if you are Medicare eligible, you are not enrolled in an employer-sponsored health plan or prescription drug plan for retirees; and you will otherwise comply with the terms above.

To the Pharmacist: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription.

• Submit transaction to McKesson Corporation using BIN #610524
• Patient must be covered by Commercial Prescription Insurance. Input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response
• Patient is not eligible if prescriptions are paid in part or full by any state or federally funded health care program, including but not limited to Medicare or Medicaid, VA, DOD or TRICARE, or where prohibited by law
• Acceptance of this card and your submission of claims for the program are subject to the LoyaltyScrip^® program Terms and Conditions posted at www.mckesson.com/mprstnc
• For questions regarding setup, claim transmission, patient eligibility, or other issues, call the LoyaltyScript^® Discount Card program at 1.855.820.0071, Monday through Friday, 8 AM to 8 PM ET

Aptiom^® (eslicarbazepine acetate) Savings Program Terms and Conditions:

• This offer is valid only for eligible patients 18 years of age or older, or legal guardians of patients between 4 and 17 years of age with a valid prescription for APTIOM within APTIOM’s approved indication(s)
• Offer not valid if prescription is paid in part or full by any state or federally funded health care program, including but not limited to Medicare, Medicaid, VA, DOD or TRICARE, or where prohibited by law
• Offer allows for savings up to $150 per 30-day prescription fill for APTIOM or the amount of your co-pay, whichever is less. Discount available on up to 12 prescription fills for APTIOM per calendar year. Individual co-pay amounts may vary
• This program is not health insurance. The amount of the benefit cannot exceed the patient's out-of-pocket expenses. Acceptance of this offer must be consistent with the terms of any drug benefit provided by a health insurer, health plan, or other third-party payer. If requested or required by any such payer, the patient must report the use of this card. The patient must deduct the value of the savings received under this program from any reimbursement request submitted to the patient’s insurance plan, either directly or on the patient’s behalf
• Offer limited to one per person
• A minimum patient requirement for participation in the program is an activated Program ID number
• Only an original (no copies) or printout of the card must be presented to participating pharmacies
• For California and Massachusetts residents, benefits pursuant to this card will terminate automatically upon the introduction of a therapeutically equivalent product
• Certain information related to your use of the Copay Savings Card may be collected, analyzed, and shared with Sunovion for market research and other purposes related to assess Sunovion's programs. Information shared with Sunovion will be aggregated and deidentified; it will be combined with other data related to other Copay Savings Card redemptions and will not identify you
• Offer valid only in the United States and Puerto Rico. Void where prohibited by law, taxed, or restricted

Sunovion reserves the right to rescind, revoke, or amend this offer at any time without notice. This offer is not transferable and may not be sold, purchased or traded, or offered for sale, purchase, or trade.

To the Patient: You must present this card to the pharmacist along with your APTIOM prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call Sunovion Answers for APTIOM^® at 1.844.4APTIOM (1.844.427.8466) 8 AM to 8 PM ET, Monday through Friday. When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions; you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription; if you are Medicare eligible, you are not enrolled in an employer-sponsored health plan or prescription drug plan for retirees; and you will otherwise comply with the terms above.

To the Pharmacist: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental program for this prescription.

• Submit transaction to McKesson Corporation using BIN # 610524
• If primary commercial prescription insurance exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response
• Acceptance of this card and your submission of claims for the program are subject to the LoyaltyScript^® program Terms and Conditions posted at www.mckesson.com/mprstnc
• Patient is not eligible if prescriptions are paid in part or full by any state or federally funded health care program, including but not limited to Medicare or Medicaid, VA, DOD or TRICARE, or where prohibited by law
• For questions regarding setup, claim transmission, patient eligibility or other issues, call the APTIOM Savings Card program at 1.866.279.8992, 8 AM–8 PM ET, Monday through Friday