The XOSPATA Patient Savings Program^a is for eligible commercially insured patients taking XOSPATA. The Program parameters are as follows:

• Patients may pay as little as $0 per prescription
• Patients will be enrolled in the Program for a 12-month period
• Patients have a maximum copay assistance limit of $7000 per calendar year^b
• There are no income requirements

ENROLLING IN THE XOSPATA PATIENT SAVINGS PROGRAM

You can fully enroll in the XOSPATA Patient Savings Program. Your healthcare provider or the specialty pharmacy can also help you.

Step 1: Go to XOSPATAcopayenroll.com

Step 2: Select "Patient" since you are filling out the information

Step 3: Answer questions to confirm your eligibility, including your insurance status and place of residence

Step 4: Your program information is provided when enrollment is completed. You can print this out

Step 5: You will also receive a mailed letter and an email (if provided during enrollment) with all of the Program information that you will need

For more information or help enrolling in the XOSPATA Patient Savings Program, please call 1-855-221-3493, Monday through Friday, 8:00 am to 10:00 pm ET.

^aBy enrolling in the XOSPATA Patient Savings Program ("Program"), the patient acknowledges that they currently meet the eligibility criteria and will comply with the following terms and conditions: The Program is for eligible patients with commercial prescription insurance coverage for XOSPATA^® (gilteritinib) and is good for use only with a valid prescription for XOSPATA. The Program is not valid for patients whose prescription claims are reimbursed, in whole or in part, by any state or federal government program, including, but not limited to, Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, Puerto Rico Government Insurance, or any state patient or pharmaceutical assistance program. Patients who move from commercial insurance to federal or state health insurance will no longer be eligible, and agree to notify the Program of any such change. Patients agree not to seek reimbursement from any health insurance or third party for all or any part of the benefit received by the patient through the Program. This offer is not conditioned on any past, present, or future purchase of XOSPATA. This offer is not transferrable and cannot be combined with any other offer, free trial, prescription savings card, or discount. The full value of the Program benefits is intended to pass entirely to the eligible patient. This offer is not health insurance and is only valid for patients in the 50 United States, Washington DC, Puerto Rico, Guam and Virgin Islands. This offer is not valid for cash paying patients. This Program is void where prohibited by law. No membership fees. It is illegal to sell, purchase, trade, counterfeit, duplicate, or reproduce, or offer to sell, purchase, trade, counterfeit, duplicate or reproduce the card. This offer will be accepted only at participating pharmacies. Certain rules and restrictions apply. Astellas reserves the right to revoke, rescind, or amend this offer without notice.

The Program has a maximum copay assistance limit of $7,000 per calendar year. After the annual maximum on copay assistance is reached, patient will be responsible for the remaining out-of-pocket costs for XOSPATA. Astellas may reduce or discontinue the copay assistance available under the Program if it determines an enrolled patient is subject to a program offered by a third-party payer or pharmacy benefit manager, or an agent of either, that adjusts patients’ out-of-pocket cost-sharing obligations based on the copay assistance provided by this Program, or excludes the copay assistance provided under this Program from counting towards an enrolled patient’s out-of-pocket cost-sharing obligations (“maximizer” or “accumulator” program). The Program uses advanced logic to identify whether a claim for an enrolled patient is subject to a “maximizer” or “accumulator” program. Unless prohibited by law, Astellas may reduce the cost-sharing assistance available under the Program to a per claim maximum of $25 if it determines a claim for an enrolled patient is subject to a “maximizer” or “accumulator” program.

^bSubject to a maximum copay assistance limit of $7000 per calendar year. Unless prohibited by law, Astellas may reduce the cost-sharing assistance available under the Program to a per claim maximum of $25 if it determines a claim for an enrolled patient is subject to a “maximizer” or “accumulator” program.