PATIENT SAVINGS PROGRAM - Xeomin

1 1*Actual patients . Please see page 10 for PATIENT indications. Please see inside for Important Consumer Safety Information. For full Prescribing Information and medication Guide, please visit Subject to eligibility. Restrictions apply to eligibility and reimbursable expenses. Please see full terms and conditions in this brochure and at Merz reserves the right to change PROGRAM Terms and Conditions, including the eligibility requirements, at any better PATIENT experiencesEligible patients can receive up to $3,500 EVERY 12 MONTHS For patients who qualify, Merz will reimburse eligible actual out-of-pocket Xeomin medication costs and related administration fees Get help with actual out-of-pocket costs associated with Xeomin treatment, including: Deductibles Co-pays Co-insuranceXEOMIN (incobotulinumtoxinA) PATIENT SAVINGS PROGRAMR uben*Jan* 2 3*Actual PATIENT .

2 Please see page 10 for PATIENT indications. Please see inside for Important Consumer Safety Information. For full Prescribing Information and medication Guide, please visit Xeomin SAVINGS in 3 Easy StepsThe Xeomin PATIENT SAVINGS PROGRAM supports eligible patients with co-pays, co-insurance, and deductibles for Xeomin and related administration costs, up to a maximum amount of $3,500 per rolling 12-month period. The initial 12-month period begins with a PATIENT s acceptance into the PROGRAM . Start saving on out-of-pocket costs with the Xeomin PATIENT SAVINGS PROGRAM in 3 easy steps: Obtain an application. Decide where you want your PROGRAM SAVINGS to go: directly to you or on your behalf to your healthcare provider (ask your doctor for more information on this option). Sign and submit your enrollment form to the PROGRAM (for your convenience, you can ask your healthcare provider to submit it for you).

3 After receiving your Xeomin injection , your healthcare provider will submit a claim to your insurance company. If approved by your insurance, you and your healthcare provider will receive a statement, called an Explanation of Benefits (EOB), outlining the costs you owe your healthcare provider for your injection. Submit your EOB to the PROGRAM (or you can ask your healthcare provider to submit it on your behalf). Depending on where you decided to have your PROGRAM SAVINGS sent, either you (or your healthcare provider on your behalf) will receive a check with your eligible SAVINGS (up to $3,500 per 12 months). Please refer to the Frequently Asked Questions on page 6 for more information on the Xeomin PATIENT SAVINGS PROGRAM and how your healthcare provider can support you with the process. You may be required to pay upfront for your co-pay/co-insurance, as determined by your insurance coverage/policy and your healthcare provider s co-pay collection *STEP ONEE nroll in the ProgramSTEP TWO Receive Your Xeomin TreatmentSTEP THREE Obtain Your PROGRAM SAVINGS 4 5 Please see inside for Important Consumer Safety Information.

4 For full Prescribing Information and medication Guide, please visit Costs (Without PROGRAM SAVINGS )gs) PATIENT Costs (With PROGRAM SAVINGS ) Xeomin Treatment 1 ( PATIENT has not yet met her deductible)$1,732$0 Xeomin Treatment 2$532$0 Xeomin Treatment 3$532$0 Xeomin Treatment 4$532$0 See how Mary s example can save her up to $3,500 Mary, 56 (For example only, not an actual PATIENT )Diagnosis: Upper Limb Spasticity After my stroke, I was blessed to work with my care team to help me regain mobility and function of my left arm. But I noticed my arm becoming stiff and painful. And my hand started to stay clenched in a fist. I was diagnosed with Upper Limb Spasticity, and my doctor felt Xeomin may be right for me. I have a commercial insurance plan that covers my Xeomin treatment, but still have out-of-pocket costs things like co-pays, co-insurance, and deductibles related to my treatment.

5 Xeomin PATIENT SAVINGS PROGRAM Example It was easy to enroll in the Xeomin PATIENT SAVINGS PROGRAM . I filled out a form and was notified that I qualified for the PROGRAM . I found out I may be eligible to receive up to $3,500 every 12 months to apply towards those out-of-pocket costs. Enroll in the Xeomin PATIENT SAVINGS PROGRAM today. Ask your doctor for more a look at the example PATIENT SAVINGS on the chart on the right:By enrolling in, and being deemed eligible for the Xeomin PATIENT SAVINGS PROGRAM , Mary pays $0 for the above Xeomin treatment. The Xeomin PATIENT SAVINGS PROGRAM is an example of how Merz can help patients receive the treatment they note Mary s story is an example calculation for illustrative purposes only and assumes hypothetical pricing for a PATIENT receiving 400 units of Xeomin in the hospital outpatient setting with a deductible of $1,500, a 20% co-insurance, and an out-of-pocket maximum of $3,500.

6 Xeomin pricing is subject to benefits may vary depending on your specific commercial insurance plan. Total out-of-pocket costs$3,3280$Not actual PATIENT 6 7*Actual patients . Please see page 10 for PATIENT indications. Please see inside for Important Consumer Safety Information. For full Prescribing Information and medication Guide, please visit Frequently Asked Questions What is the maximum amount of reimbursement I may receive?The maximum reimbursement you may receive for actual out-of-pocket Xeomin medication costs and eligible administration fees is $3,500 in a 12-month period (beginning on the date you are accepted into the Xeomin PATIENT SAVINGS PROGRAM ).Once I submit my enrollment form, how long will it take to find out if I am eligible for the PROGRAM ? Will I receive confirmation of my eligibility?

7 Your eligibility will be determined within 2-3 business days of receiving your application. You will then be mailed a welcome I be required to re-enroll in the PROGRAM after 12 months? You must re-enroll to have your eligibility re-evaluated on an annual basis (every 12 months).How can my healthcare provider support me in the PROGRAM ?You can ask your healthcare provider s office to support you with the Xeomin PATIENT SAVINGS PROGRAM in the following ways:1. They can submit your application to the PROGRAM on your behalf. 2. Within 120 days of your injection, they can submit documentation (ie, an Explanation of Benefits) to the PROGRAM to initiate your request for reimbursement from the Xeomin PATIENT SAVINGS PROGRAM . What is assignment of SAVINGS ? For your convenience and peace of mind, you can choose to assign (send) your SAVINGS directly to your healthcare provider to cover the costs you would have had to pay your provider for your Xeomin treatment.

8 For additional information or questions on assignment of SAVINGS , please contact your healthcare provider s office. What if I get my Xeomin through a specialty pharmacy? Am I still eligible for the PROGRAM ?Some patients may be eligible for coverage of Xeomin through a specialty pharmacy benefit. In this case, your Xeomin will be shipped directly to your healthcare provider s office, but will require your participation in the process. You are still eligible to participate in the Xeomin PATIENT SAVINGS PROGRAM and should talk to your healthcare provider for more information. Enrollment Is Easy:To enroll in the Xeomin PATIENT SAVINGS PROGRAM , complete application, available by: Visiting and clicking on the PATIENT SAVINGS PROGRAM link Speaking to your healthcare provider Calling 1-844-4 MYMERZ (1-844-469-6379) to reach a NEXT STEPS specialistFax your application to 1-844-711-6236 (or, for your convenience, your healthcare provider can submit it for you).

9 Ask questions about financial assistance, call a dedicated nurse, or learn more about PATIENT education resources at 1-844-4 MYMERZ (1-844-469-6379) and ask for a NEXT STEPS specialist. You can also always visit us at *Dona*Jan* 8 9 Please see inside for Important Consumer Safety Information. For full Prescribing Information and medication Guide, please visit be eligible for the Xeomin PATIENT SAVINGS PROGRAM , you must: Be a clinically appropriate PATIENT for therapeutic treatment with Xeomin , as determined by your doctor Be prescribed Xeomin Be at least 18 years of age and less than 65 years of age Have commercial insurance that covers Xeomin medication costs Not be enrolled in a state-funded or federally funded prescription insurance PROGRAM * For residents of Massachusetts, Michigan, Minnesota, and Rhode Island, further restrictions apply* Submit claims within 120 days of date of serviceThe following costs are not eligible and will not be reimbursed.

10 Office visit co-pays not directly associated with Xeomin treatment Facility co-pays not directly associated with Xeomin treatment Any other costs excluded by the PROGRAM guidelines not specifically mentioned above, which are subject to change In accordance with state law, the PROGRAM does not reimburse injection-related charges for patients residing in Massachusetts, Michigan, Minnesota, and Rhode Island *Please refer to the complete description of Eligibility, Terms and Conditions, and PROGRAM , Terms and Conditions, and PROGRAM LimitationsFrom and after July 1, 2016, the PROGRAM covers eligible patients actual out-of-pocket Xeomin medication costs and related administration fees up to a maximum amount of $3,500 per 12-month period beginning with the PATIENT s acceptance into the PROGRAM (no earlier than July 1, 2016).