To the Patient: You must present this card to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the ZUBSOLV Savings Program at 1-877-264-2440 (8:00 AM-8:00 PM EST, Monday-Friday). When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions. You are not eligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to Medicare or Medicaid, Medigap, VA, DOD or TriCare, or where prohibited by law, and you will otherwise comply with the terms above.

To the Pharmacist: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription.

• Submit transaction to McKesson Corporation using BIN #610524
• If primary coverage exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response
• Acceptance of this card and your submission of claims for the ZUBSOLV Savings Program are subject to the LoyaltyScript^® program Terms and Conditions posted at www.mckesson.com/mprstnc
• Patient is not eligible if prescriptions are paid in part or full by any state or federally funded programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD or TriCare and where prohibited by law
• For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript for ZUBSOLV Savings Program at 1-877-264-2440 (8:00 AM-8:00 PM EST, Monday-Friday)

Orexo US, Inc. reserves the right to rescind, revoke or amend this offer at any time.