Terms and Conditions for the Rituxan Immunology and ACTEMRA Co-pay Card Program for Drug Assistance

This Rituxan Immunology and ACTEMRA Co-pay Card Program is valid ONLY for patients with commercial (private or non-governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medication. Patients using Medicare, Medicaid, Medigap, Veteran's Affairs (VA), Department of Defense (DoD), TRICARE or any other federal or state government program to pay for their medications are not eligible. The Program is not valid for medications that are eligible to be reimbursed in their entirety by private insurance plans or other programs.

Under the Program, the patient will pay a co-pay. After reaching the maximum Program benefit, the patient will be responsible for all out-of-pocket costs. This Program is not health insurance or a benefit plan. The Program does not obligate the use of any specific product or provider. Patients receiving assistance from charitable assistance programs (such as Genentech Patient Foundation) are not eligible. The Co-pay benefit cannot be combined with any other rebate, free trial, or similar offer for the medication. No party may seek reimbursement for all or any part of the benefit received through this Program.

The Program may be accepted by participating pharmacies, physician offices, or hospitals. Once enrolled, this Program will not honor claims with date of service or medication dispensing that precede Program enrollment by more than 120 days. Use of this Program must be consistent with all relevant health insurance requirements. Participating patients, pharmacies, physician offices, and hospitals are responsible for reporting the receipt of all Program benefits as required by any insurer or by law. Program benefits may not be sold, purchased, traded, or offered for sale, purchase, or trade.

The patient or their guardian must be 18 years or older for the patient to be eligible. This Program is only valid in the United States and U.S. Territories. This Program is void where prohibited by law and shall follow state restrictions in relation to AB-rated generic equivalents (e.g. MA, CA) where applicable. Program eligibility is contingent upon the patient's ability to meet and maintain all requirements set forth by the Program. Genentech reserves the right to rescind, revoke, or amend the Program without notice at any time.

By using the Rituxan Immunology Administration Co-pay Program, hereafter "Program", the patient acknowledges and confirms that at the time of usage, (s)he is currently eligible and meet the criteria set forth in the Terms and Conditions described below. If the patient chooses to enroll in the Rituxan Immunology Drug Co-pay Program, the patient must separately enroll and meet all eligibility criteria of that program.

This Program is valid ONLY for patients receiving treatment for a Food and Drug Administration (FDA-approved use of the Genentech medication. The Program is only valid for patients with commercial (private or nongovernmental) insurance. Patients using Medicare, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD), TRICARE or any other federal or state government funded program (collectively, "Government Programs") to pay for their medications and/or administration services are not eligible. The patient or their guardian must be 18 years or older to receive Program assistance. The Program is only valid in the United States and U.S. Territories. The Program is not valid for Massachusetts, Michigan, Minnesota, or Rhode Island residents. This Program is not valid where prohibited by law.

This Program is not health insurance or a benefit plan. Distribution or use of the Program does not obligate use or continuing use of any specific product or provider. The patient or guardian is responsible for reporting the receipt of all Program benefits or reimbursement received, as may be required, to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Program. The patient, guardian, prescriber, hospital, and any other person using or administering the Program agree not to seek reimbursement for any part of the benefit received by the patient through the offer of this program.

This Program is only available with a valid prescription for Rituxan and cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription, except the Rituxan Immunology Drug Co-pay Program. The Program is valid administration fees for medications the patient receives for free from Genentech. The Program is not valid administrative fees that the patient may be otherwise subsidized by a non-Genentech charitable organization or healthcare plan.

Under the Program, the patient will pay a co-pay. After reaching the maximum per treatment or annual limit the patient will be responsible for all remaining pay Out-of-Pocket expenses. The amount of the Program benefit cannot exceed the patient's Out-of-Pocket expenses for the cost of administrative fees associated with Rituxan. Once enrolled, this Program will not honor claims with date of service that precede program enrollment by more than 120 days.

Use of this Program must be consistent with all relevant health insurance requirements and payer agreements. Participating patients, physician offices, and hospitals are obligated to inform third party payers about the use of the Program as provided for under the applicable insurance or as otherwise required by contract or law.

Healthcare providers may not advertise or otherwise use the Program as a means of promoting their services or Genentech's products to patients. Genentech, Inc. reserves the right to rescind, revoke, or amend the program without notice at any time.