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Getting help with my co-pay

“Co-pay” refers to a cost-sharing arrangement in which members of health insurance plans pay a specified charge for a product or service, such as a prescription or an office visit. A co-pay is usually a fixed fee, which may vary depending on the service.

Support for every step of your journey

If you have difficulty paying for your Nutropin co-pay, coinsurance or other costs, Nutropin GPS™ can refer you to an independent, nonprofit organization (INO) for financial assistance. If you are seeking a referral for co-pay assistance, you can simply call 1-866-NUTROPIN (1-866-688-7674).*

Am I eligible?

You may be referred to a co-pay assistance program if you have:

• Public insurance, such as Medicare or Medicaid
• Private insurance

Patients enrolled in Medicare Part D may be eligible to apply for co-pay assistance, including fees associated with true out-of-pocket (TrOOP) expenses.

*You do not need to enroll in Nutropin GPS to receive referrals to INOs for co-pay assistance.

We cannot guarantee co-pay assistance once you have been referred by Nutropin GPS. The INOs to which we refer patients each have their own criteria with regard to eligibility, including financial eligibility. Genentech and Nutropin do not influence or control the operations of these INOs, but Nutropin GPS can help you navigate the process of seeking co-pay assistance by referring you to an appropriate organization and by assisting with the application process.

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The Nutropin GPS Co-pay Card

The Nutropin GPS Co-pay Card makes it easier for patients who qualify to access Nutropin, by helping you with the out-of-pocket (OOP) costs of your Nutropin prescription. Patients can get up to $4000 in co-pay assistance (patients requesting more than $1500 in co-pay support pay 20% in coinsurance and must be financially eligible to qualify).

Support to make your journey easier

Ask your doctor for the Nutropin GPS Co-pay Card brochure (it comes with a Nutropin GPS Co-pay Card inside), or call 1-866-NUTROPIN (1-866-688-7674) to learn how you can get a card. Once you have your card, take these 3 simple steps:

1. Call 1-866-NUTROPIN (1-866-688-7674) to register your card. An interactive voice recording system will ask you to provide the following information:

• Your home phone number
• Your ZIP code
• The 7-digit number following the 2 letters on the bottom left of your debit card

2. Receive confirmation of card activation. Once your eligibility has been confirmed, you will receive a letter within 5 days to let you know that your card has been successfully activated.

3. Receive access support for Nutropin. Simply provide the 16-digit number located on the front of your Nutropin debit card to your participating Specialty Pharmacy.

Questions?

Please call us toll free at 1-866-NUTROPIN (1-866-688-7674). We are available Monday through Friday, 9:00 am to 8:00 pm Eastern Time.

TERMS AND CONDITIONS

The Nutropin GPS Co-pay Card may only be used for Nutropin therapy. This card does not obligate you to use Nutropin. Should your healthcare provider change your therapy regimen please follow the advice of your healthcare provider. Patient Eligibility Criteria: Insurance coverage must be through one of the participating Specialty Pharmacies; patient is not a resident of Massachusetts; patient is not a participant in GATCF (Genentech Access To Care Foundation); patient is not a participant in any state or federally funded healthcare programs.

Offer good in the United States. Genentech reserves the right to rescind, revoke, or amend this offer without notice at any time.

No person or entity may seek reimbursement from any third-party payer for any amount provided through this program. Genentech USA, Inc. reserves the right to deny payment under the card to anyone deemed ineligible in accordance with the stated program criteria. Use of the card does not obligate you to use or continue using any specific product or provider.

Providers may not advertise or otherwise use the card as a means of promoting their services or Genentech's products to patients.

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IMPORTANT SAFETY INFORMATION

Nutropin and your safety:
Please read this important safety information carefully. Then, if you have any questions, talk with your doctor.

Nutropin is NOT for:

• Children and teenagers whose bones have finished growing
• Patients who have certain types of eye disease caused by diabetes
• Patients who have active cancer or any brain tumors
• Patients who are critically ill after open heart surgery or abdominal (stomach) surgery, are severely hurt, or have severe breathing problems
• Children and teenagers who have Prader-Willi syndrome and are very overweight or have trouble breathing
• Patients with a known sensitivity to benzyl alcohol, an ingredient in the liquid used to mix Nutropin Injection. Sterile water should be used when mixing Nutropin for newborns.

If any of these apply, talk to your doctor before you start taking Nutropin.

If you are about to start taking Nutropin, or are already taking it, be sure to tell the doctor who prescribed it:

• About ALL of the medications you are taking, including supplements
• If you have or develop a brain tumor
• If you are given any new medication, especially glucocorticoid steroids like hydrocortisone or prednisone
• If you are pregnant or if you become pregnant
• About ANY other condition or illness you have or develop

What are the possible side effects of Nutropin?
You may experience discomfort, soreness, or redness where Nutropin is injected.

Contact your doctor immediately if you experience:

• Ongoing injection site discomfort
• Curvature of the spine (scoliosis)
• Joint pain
• Puffy hands and/or feet (caused by fluid retention)
• Changes in vision, a bad headache, or nausea with or without vomiting
• Hip or knee pain
• A need to limp when you walk
• Pain in wrist (carpal tunnel)
• Allergic reaction

Be sure to inject Nutropin at a different recommended place on your body each time. Your doctor or nurse should supervise the first injection and provide training and instruction.

Your doctor is your primary source of information about your treatment.

Please see the full Prescribing Information for Nutropin and Nutropin AQ, available from your pharmacy and at www.nutropin.com, for more about Nutropin and safety.

Questions? Call the Nurse Hotline at 1-866-NUTROPIN (1-866-688-7674).

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