The ZULRESSO Drug Copay Assistance Program (the “Drug Copay Program”) helps eligible patients with private, commercial health insurance pay for a patient’s out-of-pocket costs associated with the drug up to a maximum of $15,000. Cash-paying
patients and patients eligible for a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico
(formerly known as “La Reforma de Salud”), are not eligible to participate in the Drug Copay
Program. Sage Therapeutics, Inc., may rescind, revoke, or amend the Drug Copay Program at any
time. For full patient eligibility requirements and program terms and conditions, visit
SageCentralSupport.com.
The ZULRESSO Infusion Copay Assistance Program (the
“Infusion Copay Program”) helps eligible patients with private, commercial health insurance pay
for a patient’s out-of-pocket, infusion-related costs associated with ZULRESSO up to a maximum
of $2,000. Cash-paying patients and patients eligible for a state or federally funded insurance
program, including but not limited to Medicare, Medicaid. TRICARE, Veterans Affairs health care,
a state prescription drug assistance program, or the Government Health Insurance Plan available
in Puerto Rico (formerly known as “La Reforma de Salud”), are not eligible to participate in the
Infusion Copay Program. Residents of Massachusetts and Rhode Island are not eligible to
participate in the Infusion Copay Program. Sage Therapeutics, Inc., may rescind, revoke, or amend
the Infusion Copay Program at any time. For full patient eligibility requirements and program
terms and conditions, visit SageCentralSupport.com.
To be eligible to participate in the ZULRESSO “Free Drug
Program” (the “FOP”), the patient must: (i) Be prescribed ZULRESSO for an on-label diagnosis;
(ii) Have household income less than or equal to 500% of the Federal Poverty Level (FPL); (iii)
Be uninsured or rendered uninsured under any of the following circumstances: (a) Patient has no
healthcare insurance, (b) Patient is insured but such insurance does not cover ZULRESSO, or (c)
Patient is insured with coverage for ZULRESSO, but is ineligible for the ZULRESSO Copay
Assistance Programs, and cannot afford the medication (patient out-of-pocket costs are greater
than $25); (iv) Reside in the United States or a U.S. territory: (v) Be treated by a healthcare
professional in the United States or a U.S. territory; and (vi) Be 15 years of age or older.
Patients enrolled in Medicare, Medicaid, or any other federal or state funded health plan may
participate in the FOP if they receive the free product outside of their government-funded
benefits. The treating healthcare provider must certify that based on their independent medical
judgment, ZULRESSO is a medically appropriate treatment for the patient. The healthcare provider
must agree not to bill the patient or the patient’s insurer for any costs associated with
ZULRESSO and the corresponding treatment, including costs associated with the infusion of
ZULRESSO (administration, needles, tubing, infusion bags, syringes, infusion pump, preparation
of medication, and IV access) and hospital room and board costs. The healthcare provider must
certify that they will not seek reimbursement from any third-party payer or government program
for the cost of ZULRESSO or any costs associated with the infusion of ZULRESSO. The patient will
be informed that they must not (i) seek reimbursement for the free drug from their health plan,
and (ii) count the cost of the free drug towards their out-of-pocket spending requirements, if
any, under their insurance. The free drug provided under the FOP is not conditioned on any past
or future purchases. For any patient enrolled in a readily identifiable Medicare, Medicaid, or
other government funded plan, Sage will send a letter to the plan informing it that: (i) the
patient is receiving free product from the ZULRESSO FOP outside of the patient’s
Medicare/Medicaid plan benefit, (ii) the patient and their physician have been informed that
they must not seek reimbursement for the free drug from their health plan or count the cost of
the free product towards the patient’s out-of-pocket spending requirements, and (iii) the plan
should discontinue any pending prior authorization or coverage appeal associated with the
patient.