Helping eligible patients with out-of-pocket costs

The CareConnectPSS^® Copay Assistance Program* helps eligible patients in the United States who are prescribed Aldurazyme pay for their qualifying out-of-pocket drug costs and certain infusion‑related expenses (mixing and administration of the drug, as well as infusion supplies such as, for example, saline and IV tubing), including copays, coinsurance, and deductibles.

The program* is open to individuals who:

• Have commercial insurance
• Have prescription drug coverage
• Are prescribed one of Sanofi’s treatments
• Are residents of the United States

Not valid for prescriptions paid, in whole or in part, by Medicaid, Medicare, VA, DOD, TRICARE, or other federal or state programs including any state pharmaceutical assistance programs. No claim for reimbursement of any out-of-pocket costs covered by the Copay Program may be submitted to any third-party payer, whether public or private, including but not limited to patients’ insurance, Flexible Spending Account (FSA), Health Savings Account (HSA), or any other type of medical savings account.

This program is not valid where prohibited by law, taxed, or restricted. Sanofi reserves the right to rescind, revoke, terminate, or amend this offer, eligibility, and terms of use at any time without notice. Any savings provided by the program may vary depending on patients’ out-of-pocket costs. Patients will receive all program details upon registration.

*This guide is provided for informational purposes only and does not constitute legal or reimbursement advice. It is not intended to substitute for the physician’s independent diagnosis or treatment of each patient. The information contained herein is gathered from various resources and is subject to change. Providers are solely responsible for the accuracy of all coding and claims submitted for reimbursement to any third-party payer.

Sanofi Charitable Access Program

The Sanofi Charitable Access Program was established in the United States to provide Sanofi’s therapies to eligible individuals who do not have health insurance or have inadequate coverage for treatment. It is considered a temporary solution until long-term coverage can be secured.

This program has been established in the US through the Sanofi Charitable Foundation, Inc. The program is committed to make Aldurazyme accessible to individuals who satisfy the following 2 requirements:

• Medically need Aldurazyme
• Are uninsured or have inadequate insurance coverage for Aldurazyme

Qualified individuals with MPS I whose physicians have recommended treatment with Aldurazyme may be eligible for the Charitable Access Program. If a patient is ineligible for our program, their CareConnectPSS Case Manager will work with the patient and their healthcare providers to explore alternative coverage options.

To be considered for the program, the following documentation are required:

• A Letter of Intent to Treat With Aldurazyme
• A Statement of Medical Necessity
• A completed program application

A CareConnectPSS Case Manager will coordinate with you and your patient to obtain the necessary documentation, and will keep you updated on the status of your patient’s application.

Please note, all Charitable Access Program applications are reviewed monthly and kept confidential. The Charitable Access Program is considered a temporary program. Patients and their families are expected to continue to explore alternative resources with the assistance of a CareConnectPSS Case Manager. These resources may include:

• Private insurance
• Government programs

If you have questions about Sanofi’s Charitable Access Program or want to request an application form, please call 1-800-745-4447, Option 3, to speak with a CareConnectPSS Case Manager.

Disclaimer: The Sanofi Charitable Access Program may be discontinued at any time at the discretion of the Charitable Access Program Committee.

CareConnectPSS^® is a registered trademark of Sanofi or an affiliate.