ASTRAZENECA

AstraZeneca offers the AstraZeneca Access 360™ for patients prescribed an AstraZeneca product. The program provides personal support to help streamline access and reimbursement for select AstraZeneca medicines.

For more information on Access 360, search the prescribed product in this Guide, go online, or call 1.844.275.2360, Monday through Friday, 8:00 AM to 6:00 PM EST, excluding holidays.

Oncology-related products: Calquence® (acalabrutinib) tablets, Faslodex® (fulvestrant) injection, Imfinzi® (durvalumab) injection for intravenous use, Imjudo® (tremelimumab-actl) injection for intravenous use, Iressa® (gefitinib) tablets, Lynparza® (olaparib) tablets, Tagrisso® (osimertinib) tablets, Truqap® (capivasertib)

Reimbursement Assistance

AstraZeneca Access 360™

Access 360 can assist healthcare providers and patients with:

• Benefit investigation
• Prior authorization support
• Pharmacy research
• Pharmacy coordination
• Claims and appeal process support
• Affordability support.

For more information, call 1.844.275.2360, Monday through Friday, 8:00 AM to 6:00 PM EST or visit myaccess360.com.

Independent Charitable Foundations/Organizations

AstraZeneca Access 360™ Referrals

Assistance may be available through independent foundations, such as those listed on the Access 360 website. Foundations can provide a variety of assistance types, like co-pay, transportation, premium, patient education, etc.

Co-Pay Card/Out-Of-Pocket Cost Assistance

AstraZeneca Patient Savings Programs

The goal of the AstraZeneca Patient Savings Programs is to assist eligible patients with their out-of-pocket costs. Most eligible patients will pay $0 per supply or infusion, dependent on the specific medication, and is subject to annual maximums. There are no income requirements to participate in these programs.

Patients are ineligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, Veterans Affairs, or TriCare, or where prohibited by law. Eligibility rules apply. Offer is invalid for claims and transactions more than 120 days from the date of service.

How the Programs Work:

1. Patients may have an out-of-pocket cost for an AstraZeneca specialty product.
2. If the patient meets the eligibility requirements, health care professionals can enroll their patients into the Patient Savings Program via www.AZPatientSupport.com.
3. A Patient Savings Program account will be created for the eligible patient. Once enrolled, patient-specific account information will be presented in the portal for immediate use.
4. The patient will pay a set amount of their out-of-pocket costs, based on the product. The pharmacy or health care provider will use the Patient Savings Program to cover the balance.

Program benefits include:

• For Calquence, eligible patients may pay as little as $0 per month.
  
• For Faslodex, patient pays $0 per dose, program pays remaining out-of-pocket costs up to a maximum of $6,000 per year.
• For Imfinzi eligible patients may pay as little as $0 per month.
• For Imjudo, eligible patients may pay as little as $0 per month.
• For Lynparza, eligible patients may pay as little as $0 per month.
• For Tagrisso, eligible patients may pay as little as $0 per month.
• For Truqap, eligible patients may pay as little as $0 per month.

For more information about eligibility and details on these programs, visit the savings programs website or call 1.844.275.2360, Monday through Friday, 8:00 AM to 6:00 PM EST.

Patient Assistance Program

The AZ&Me™ Prescription Savings Program

The AZ&Me Prescription Savings Program is designed to help qualifying patients without insurance and those with Medicare who are still having trouble affording their AstraZeneca medications.

Eligibility Requirements:

• Patient must be a resident of the United States.
• Patient must not be currently receiving prescription drug coverage under a private insurance or government program (excluding Medicare),or receiving any other assistance to help pay for medicine.
• Patient's annual income must be at or below a certain level.
• If the patient is a Medicare beneficiary, they must not be eligible for or enrolled in Low Income Subsidy for Medicare Part D.

The following items must be submitted to complete the patient application:

• A completed application, signed and dated by the patient and prescriber.
• An electronic prescription or the completed prescription on page three of the application.

To apply for the program, patients and providers may either visit its website to begin the enrollment process online or call 1.800.292.6363. Applications can also be faxed to 1.877.239.0867. For an updated list of the medications available through the AZ&Me Prescription Savings Program, visit the Medications & Applications page on the AZ&Me website.

Please note that faxed applications must be sent from a health care provider’s office in order for the prescription to be processed.

For more information, visit azandme.com or call 1.800.292.6363.