TAILOR-MADE THERAPIES T & C

Since your physician has prescribed an AstraZeneca product included in this program, and the respective validation of eligibility criteria for inclusion has been completed, you have been accepted for enrollment in the AstraZeneca Patient Access Program “Tailor-made Therapies” (the Program). The Program was created to support patients’ needs through a collaborative model in which both patients and AstraZeneca share the cost of the AstraZeneca treatment prescribed by your doctor (Enhertu®, Calquence®, Fasenra®, Imfinzi®, Lynparza®, Saphnelo®, and Tagrisso®). You will benefit from a fixed support scheme, under which you will purchase the defined number of months of AstraZeneca treatment according to your therapy and receive one (1) additional month of treatment free of charge. The Program is part of AstraZeneca’s Patient Support Program, “Disfruto Mi Salud” (DMS) services, so you must also accept the DMS Terms and Conditions as well as the informed consent for Disfruto Mi Salud. This document will provide you with additional information regarding the Access Program; it is important to clarify that it does NOT replace the directions given by your doctor or medical care team. If you have questions about your treatment, you should discuss them with your treating physician.

HOW DOES THE ACCESS PROGRAM WORK?

• Your doctor has informed you about the Access Program. The information obtained from you upon entering the Program will be stored according to the terms and conditions you accepted as a prior step in “Disfruto Mi Salud.”
• The Access Program may be terminated if documented lack of response to your treatment, intolerance or toxicity to the treatment occurs, or if your physician indicates the need to discontinue treatment.
• You and your treating physician are responsible for the administration of the prescribed product.
• Administration costs or therapy-related expenses must be assumed by you as the patient (if applicable); these will not be covered by AstraZeneca and must be coordinated with your treating physician.
• You must inform the Program immediately if your physician considers discontinuing treatment to finalize your participation in the Program.

WHAT WILL YOU RECEIVE AS PART OF THE ACCESS PROGRAM?

• You will receive a fixed support scheme, under which you will purchase the defined number of months of AstraZeneca treatment according to your therapy and receive one (1) additional month of treatment free of charge.
• The supply of the approved product for the Program will be delivered to you for use in line with the approved insert of the product in your country and under your physician’s instructions.
• Supply will be coordinated with the designated AstraZeneca patient program manager, your physician, and the authorized pharmacy or clinic for purchase and delivery.

HOW LONG WILL YOU RECEIVE TREATMENT IN THE ACCESS PROGRAM?

• You will receive treatment with the AstraZeneca product approved for the Program, starting from the moment you complete the enrollment process and coordinate purchase and delivery.
• You will benefit from the 1+1 scheme (one month purchased + one month free) for the period your physician deems continuation of treatment is appropriate. For continued benefit under the 1+1 scheme, purchase of one treatment per month is required.
• As a patient, you may choose to withdraw from the Program at any time you or your physician consider appropriate.
• If you do not proceed with the planned purchase of your treatment for a continuous period of four months, you will be notified and deactivated from the Program.
• The provision of the bonused treatment benefit under the AstraZeneca Program may end if documented lack of response to treatment, intolerance or toxicity to therapy occurs, or following an indication to discontinue by your physician.
• AstraZeneca reserves the right to discontinue the “Tailor-made Therapies” Program. In such case, you will be notified so you can discuss with your physician the continuation of your benefit, provided the clinical benefit of treatment is confirmed.

TREATMENT COVERAGE STATEMENT

By reading and accepting this document, you declare that you have insufficient coverage to purchase the AstraZeneca treatment prescribed by your physician, or that your private insurance coverage (if any) does not fully cover the cost of treatment.

COLLECTION AND REPORTING OF SAFETY INFORMATION

If, as a patient, you experience any adverse event (AE), dose reduction or interruption due to an AE, a special situation, or a complaint about product quality, you must report it to AstraZeneca Patient Safety through:

• Online reporting portal https://www.contactazmedical.astrazeneca.com
• Contacting a local AstraZeneca representative to proceed with the report

ASTRAZENECA PATIENT-SPECIFIC THERAPIES