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Stemline Commercial Co-Pay Program Terms and Conditions

By using the Stemline Commercial Co-Pay Program, the patient acknowledges and confirms that, at the time of usage, (s)he is currently eligible and meets the criteria set forth in the terms and conditions described. The Stemline Commercial Co-Pay Program is valid ONLY for patients with commercial (private or nongovernmental) insurance who are taking the medication for an FDA-approved indication. Patients using Medicare, Medicaid, or any other federal or state government-funded program to pay for their medications are not eligible. Patients who start utilizing their government coverage during their enrollment period will no longer be eligible for the program. Patients may pay as little as $0 per month and Stemline Therapeutics, Inc. will pay the remaining out-of-pocket cost up to a maximum of $25,000 per calendar year. Any costs exceeding the maximum of $25,000 are the responsibility of the patient. This Commercial Co-Pay Program is not health insurance or a benefit plan. Distribution or use of the Stemline Commercial Co-Pay Program does not obligate use or continuing use of any specific product or provider. Patient or guardian is responsible for reporting the receipt of all Commercial Co-Pay Program benefits or reimbursement received to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Commercial Co-Pay Program, as may be required. The Commercial Co-Pay Program is not valid for medications the patient receives for free or that are eligible to be reimbursed by private insurance plans or other healthcare or pharmaceutical assistance programs that reimburse the patient in part or for the entire cost of his/her Stemline medication. Patient, guardian, pharmacist, prescriber, and any other person using the Commercial Co-Pay Program agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer. The Stemline Commercial Co-Pay Program will be accepted by participating pharmacies, physician offices, or hospitals. To qualify for the benefits of this Commercial Co-Pay Program, the patient may be required to pay out-of-pocket expenses for each treatment. This Commercial Co-Pay Program is only available with a valid prescription and cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Use of this Commercial Co-Pay Program must be consistent with all relevant health insurance requirements and payer agreements. Participating patients, pharmacies, physician offices, and hospitals are obligated to inform third-party payers about the use of the Commercial Co-Pay Program as provided for under the applicable insurance or as otherwise required by contract or law. The Commercial Co-Pay Program may not be sold, purchased, traded, or offered for sale, purchase, or trade. The Commercial Co-Pay Program is limited to 1 per person during this offer period and is not transferable. Program eligibility period is contingent upon the patient's ability to meet and maintain all requirements as set forth by the program. Stemline Therapeutics, Inc. may periodically verify eligibility and will terminate patients without obligation to pay claims if change to status is detected. This program is not valid where prohibited by law and shall follow state restrictions in relation to AB-rated generic equivalents where applicable (i.e., MA, CA). The patient must be 18 years or older to receive Commercial Co-Pay Program assistance. This Commercial Co-Pay Program is (1) void if reproduced; (2) void where prohibited by law; (3) only valid in the United States and Puerto Rico; and (4) only valid for FDA-approved on-label indications of Stemline products. Healthcare providers may not advertise or otherwise use the program as a means of promoting their services or Stemline Therapeutics, Inc. products to patients. Stemline Therapeutics, Inc. reserves the right to rescind, revoke, amend, or terminate the program without notice at any time.