The Patient Access Network (PAN) Foundation Eligibility Diseases Targeted Contact Information

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1 The Patient Access Network (PAN) Foundation is an independent non-profit organization that provides assistance to underinsured patients for their out-of-pocket expenses through more than 40 disease-specific funds including Oncology, Rare Disease, and Chronic Disease for life-saving medications. 90 cents of every dollar donated to PAN goes directly to patients. Since 2004, PAN has awarded over $187 million dollars in assistance to more than 134,000 underinsured patients in need. Patient must have been diagnosed with a disease for which PAN has a fund. The medication must treat the disease directly. Patient must be insured and insurance covers the medication for which patient seeks assistance. Patient must reside and receive treatment in the US. Patient s income must be at or below a designated percentage of the Federal Poverty Level, depending on individual fund requirements Acromegaly Hodgkin s Lymphoma Renal Cell Carcinoma Advanced Basal Cell Carcinoma Idiopathic Thrombocytopenic Purpura Respiratory Syncytial Virus Anaplastic Large Cell Lymphoma Kidney Transplant Immunosuppressant Rheumatoid Arthritis Ankylosing Spondylitis Metastatic Breast Cancer Secondary Hyperparathyroidism Bone Metastases Metastatic Castrate Resistant Prostate Cancer Short Bowel Syndrome Chemotherapy Induced Neutropenia Methicillin-resistant Staphylococcus Aureus Solid Organ Transplant (MRSA) Chronic Lymphocytic Leukemia Multiple Myeloma Uveitis Colorectal Cancer Multiple Sclerosis Well-Differentiated Thryoid Cancer Cutaneous T-Cell Lymphoma Myelodyplastic Syndrome Cytomegalovirus Myelofibrosis Diabetic Foot Ulcers Myeloproliferative Neoplasms Gaucher Disease Non-Small Lung Cancer Growth Hormone Deficiency Plaque Psoriasis Hepatitis B Postmenopausal Osteoporosis Hepatitis C Psoriatic Arthritis PAN Foundation P.O. Box Charlotte, NC PANF (7263)

2 Patient Services, Inc. (PSI) is a non-profit charitable organization which provides a "safety net" for patients with chronic illnesses struggling to keep up with expensive premiums and co-payments. Since 1989 it has provided much needed assistance, to patients living with specific chronic illnesses by: Locating health insurance in all 50 states Subsidizing the cost of health insurance premiums Providing pharmacy and treatment co-payment assistance Assisting with Medicare Part D Co-insurance Helping with advocacy for Social Security Disability Families affected by the listed Illnesses and Conditions are eligible to apply. Assistance is determined using a sliding scale that includes several factors such as household income, number of dependents and the state in which a person lives. Patient must have insurance, reside in the US and receive treatment from a US provider. Alpha 1- Antitrypsin Deficiency Fabry Disease Mucopolysaccharidosis (MPS1) Bone Metastases Gastrointestinal Stromal Pleural Effusion Tumors Breast Cancer Screening Hemophilia Pompe Disease Chronic Inflammatory Hereditary Angioedema Primary Immune Deficiency Demyelinating Polyneuropathy Chronic Myelogenous Inhibitors in Bleeding Pseudobulbar Affect Leukemia Clostridium Difficile Malignant Ascites von Willebrand Disease Complement Mediated Metastatic Melanoma Diseases Cystic Fibrosis with Pseudomonas Aeruginosa Metastatic Renal Cell Carcinoma Patient Services, Inc. P.O. Box 5930 Midlothian, VA

3 Chronic Disease Fund (CDF), founded in 2003, is an independent 501(c) (3) non-profit charitable organization that helps patients with more than two dozen chronic disease, cancer and other life-altering conditions obtain the life-saving medications they need. It is limited in the financial support it can provide for each disease, as it is based on the funding it raises each year through grants and contributions. CDF receives no government assistance. It measures its effectiveness in the delivery of co-pay assistance by Direct-To-Patient Assistance (DTPA). This measures how many cents of each dollar we receive that goes directly to funding out-of-pocket costs on a calendar year basis. Currently, CDF maintains a DTPA of 91% the highest in the industry. CDF has helped cover over $600 million in co-pay assistance. Patient must reside in the US Patient must financially qualify with public or private insurance, and be unable to afford the cost of their specialty therapeutics. Acute Exacerbations of Multiple Sclerosis Metastic Melanoma Renal Angiomyolipoma in individuals with Tuberous Sclerosis Advanced Medullary Thyroid Cancer Multiple Myeloma Resistant or Intolerant Chronic Myeloid Leukemia Age-Related Macular Degeneration Multiple Sclerosis Retinal Vein Occlusion (Macular Edema; Cystoid Macular Edema; Venouse Tributary Occlusion) Chronic Granulomatous Disease Myelodysplastic Syndrome (MDS) Rheumatoid Arthritis Exacerbations Chronic Iron Overload Myelofibrosis Severe Malgnant Osteopetrosis Colorectal Cancer Nephrotic Syndrome Subependymal Giant Cell Astrocytoma in patients with Tuberous Sclerosis Dermatomyositis/Polymositis Opsoclonus Myoclonus Diabetic Macular Edema Pancreatic Cancer Infantile Spasms Progressive Neuroendocrine Tumors of Pancreatic Origin Liver Cancer Chronic Disease Fund 6900 N. Dallas Parkway Suite 200 Plano, TX

4 HealthWell Foundation, founded in 2003, is an independent, non-profit organization that provides financial assistance to eligible individuals to cover coinsurance, copayments, health care premiums and deductibles for certain medications and therapies. If an insured patient has been prescribed a medication and cannot afford the coinsurance or copayment required, the HealthWell Foundation may be able to help by paying for part of the costs associated with the medication. Also, if a patient is eligible for health insurance, but cannot afford the insurance premium, HealthWell may be able to help with the costs of the insurance premium. HealthWell Foundation receives donations from a number of sources in and outside of the health care industry, including pharmaceutical manufacturers and other health care organizations and individuals. HealthWell Foundation has already provided financial assistance to over 150,000 patients. Patient must have some form of health insurance that covers part of the cost of his/her medication. Patient must have diagnosis that is currently on the list of covered conditions. Financial criteria are based upon multiples of the federal poverty level, which takes into account a family s size. Families with incomes up to four times (400%) of the federal poverty level may qualify. Acute Porphyrias Chronic Gout Immunosuppressive Treatment for Solid Organ Transplant Recipients ANCA - Associate Vasculitis and Wegener's Chronic Myeloid Leukemia - Medicare patients only Inflammatory Bowel Disease (includes Crohn s Disease and Ulcerative Colitis)-Medicare patients only Asthma, Moderate to Severe Cytomegalovirus Secondary Hyperparathyroidism AutoImmune (includes Ankylosing Spondylitis, Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis) Medicare patients only Dupuytren's Disease Systemic Lupus Erythematosus Carcinoid Tumors and Associated Symptoms-Medicare patients only The HealthWell Foundation P.O. Box 4133 Gaithersburg, MD Head and Neck Cancer Wilms' Tumor

5 Caring Voice Coalition, founded in 2003, was formalized to help patients with rare, chronic or life-threatening illnesses (orphan diseases). Patient must have one of the specific chronic illnesses supported by Caring Voice Coalition Demonstrate financial hardship Have a prescription co-payment or health insurance premiums that he or she cannot afford to pay Be on an expensive FDA-approved therapy for the treatment of his/her disease which is covered under the patients health insurance policy Reside in the US or one of its territories Not be receiving or eligible for assistance from other charitable organizations Alpha-1 Antitrypsin Deficiency Congenital Factor XIII Deficiency Infantile Spasms Chronic Granulomatous Disorder Pulmonary Fibrosis Narcolepsy Complex Partial Seizures Huntington s Disease Pulmonary Hypertension Caring Voice Coalition, Inc Meadowbridge Road Mechanicsville, VA Toll-Free Main

6 The Assistance Fund, founded in 2009, was created to make access to medications a reality for patients who are critically or chronically ill. The Assistance Fund has raised more than $78 million and is assisting children and adults across the United States and Puerto Rico. 91 cents of every dollar goes to patient care. US Citizen or permanent resident Meet financial criteria based on household size and household income Diagnosed with a program related illness Prescribed one of the supported medications Insurance coverage for the prescribed medication Breast Cancer Hereditary Angioedema Non-small Lung Cancer Clostridium Difficile Associated Idiopathic Parkinson s Psoriasis Diarrhea Colorectal Cancer Multiple Myeloma Rheumatoid Arthritis Crohn s Disease Multiple Sclerosis Wet Eye Age-Related Macular Degeneration Cystic Fibrosis Myelodysplastic Syndrome (MDS) The Assistance Fund, Inc Millenia Boulevard, Suite 500 Orlando, FL

7 The Patient Advocate Foundation (PAF) Co-Pay Relief Program (CPR) provides direct financial support for pharmaceutical co-payments to insured patients, including Medicare Part D beneficiaries, who financially and medically qualify. Since inception in 2004, it has served over 65,000 patients and allocated over $150 million dollars in copayment support to patients in need. Patient must have insurance coverage for pharmaceuticals (includes Medicare Part D coverage) Patient must have a qualifying diagnosis verified by physician Patient must meet household income guidelines of 500% or less of the federal poverty level Breast Cancer Hormone Suppression Therapy Osteoporosis Chemo Induced Neutropenia Renal Cell Carcinoma Pain Colon Cancer Lung Cancer Prostate Cancer Cutaneous T-Cell Lymphoma Multiple Myeloma Rheumatoid Arthritis (RA) Electrolyte Imbalance Myelodysplastic Syndrome Sarcoma Hepatitis C Non Muscle Invasive Bladder Cancer Co-Pay Relief 421 Butler Farm Road Hampton, VA Toll-Free Local

8 The CancerCare Co-Payment Assistance Foundation is a nonprofit organization that helps people being treated for cancer afford co-payments for chemotherapy and targeted treatment drugs, ensuring their access to care for prescribed treatments. The Foundation is affiliated with CancerCare, a national nonprofit organization founded in 1944 that provides free, professional support services to individuals, families, caregivers, and the bereaved to help them better cope with and manage the emotional and practical challenges arising from cancer. Services include counseling and support groups, educational publications and workshops, and financial assistance. All services are provided by professional oncology social workers and are offered completely free of charge. Patients with household incomes up to four times (400%) the federal poverty level may qualify. Patient must be diagnosed with one of the cancer types that the Foundation currently covers. If patient diagnosis is not listed, co-payment specialists can provide information about other possible assistance programs. Diagnosis must be verified by a doctor who must complete and sign the physician verification form. Patient must be in active chemotherapy or targeted treatment when application is submitted to the Foundation and at the time of approval. Patient must receive treatment in the US. Breast Cancer (Metastatic) Glioblastoma Pancreatic Cancer Colon or Colorectal Cancer Head and Neck Cancer Prostate Cancer Gastric Cancer Non-Small Cell Lung Cancer Renal Cell Cancer CancerCare Co-Payment Assistance Foundation 275 Seventh Avenue, 22 nd Floor New York, NY COPAY ( )

9 The Leukemia & Lymphoma Society (LLS) has been dedicated to curing leukemia, lymphoma and myeloma since LLS is the world's largest voluntary (nonprofit) health organization dedicated to funding blood cancer research and providing education and patient services. The Leukemia & Lymphoma Society Co-Pay Assistance Program helps you pay your insurance premiums and meet co-pay obligations. It also helps find additional sources of financial help. LLS's Co-Pay Assistance Program offers financial help toward: cancer treatment-related co-pays private health insurance premiums private insurance co-pay obligations Medicare Part B, Medicare Plan D, Medicare Supplementary Health Insurance, Medicare Advantage premium, Medicaid Spend-down or co-pay obligations Patient must have prescription insurance coverage to qualify and maintain insurance coverage at all times and the requested assistance must be covered by the patient s insurance carrier. Provider must confirm patient diagnosis is currently covered in the LLS s Co-Pay Assistance Program. Patient must have household income at or within 500% of the federal poverty guidelines. Patient must reside in the US or Puerto Rico and be medically and financially qualified. Acute Myeloid Leukemia Juvenile Myelomonocytic Leukemia Myelodysplastic Syndromes Acute Lymphoblastic Leukemia Large Granular Lymphocytic Leukemia Myeloproliferative Neoplasms Chronic Lymphocytic Leukemia Non-Hodgkin Lymphoma Hairy Cell Leukemia Hodgkin Lymphoma Chronic Myelomonocytic Leukemia Myeloma The Luekemia & Lymphoma Society Co-Pay Assistance Program P.O. Box Newport News, VA Toll-Free

10 The American Kidney Fund (AKF) was founded in 1971 and leads the nation in providing charitable assistance to dialysis patients who need help with the costs associated with treating kidney failure. In 2011, nearly 90,000 people almost 1 out of every 4 dialysis patients in the United States received assistance from the American Kidney Fund for health insurance premiums and other treatment-related expenses. Through the Health Insurance Premium Program (HIPP), the American Kidney Fund pays Part B Medicare, Medigap, commercial, and COBRA premiums for dialysis patients who have insufficient income and savings. These premium payments allow patients to continue their health insurance coverage, enabling access to physician care and medical treatment. Applicants must be dialyzed in the U.S. or its territories and referred to AKF by their renal social worker and/or nephrologist. Applicants must demonstrate that they can t afford health coverage and meet the program's financial eligibility criteria. Primary and secondary assistance is available only. HIPP does not assist with tertiary coverage of any kind. Transplant patients are not eligible for HIPP. HIPP enrollees will no longer be eligible for premium assistance after they receive a kidney transplant. Disease Targeted Kidney Disease American Kidney Fund Rockville Pike, Suite 300 Rockville, MD