The LEQEMBI Copay Assistance Program is sponsored by Eisai. This program
is available to help eligible commercially insured patients with their
medication cost. Patients with a state or federally funded insurance, such as
Medicare Part B or Medicaid, are not eligible for the program.

Copay Assistance Program terms and conditions

Patient must be prescribed LEQEMBI for an FDA-approved indication. Patient
must have private, commercial health insurance that provides coverage for
LEQEMBI. The offer is not valid for patients enrolled in state and federal
healthcare programs, including Medicare, Medicaid, Medigap, VA, DoD, or
TRICARE. The offer is not valid for uninsured or self-paying patients, or for
LEQEMBI treatments reimbursed in full by any third-party payer. Patient must
be 18 years or older. Patient must be a resident of, and product must be
administered in, the United States or Puerto Rico.

The benefit available under the LEQEMBI Copay Assistance Program is limited
to patient's out-of-pocket cost for LEQEMBI, as indicated in documentation
provided by the patient's health insurance provider, including a CMS-1500 or
UB-04 Form AND an insurance explanation of benefits (EOB) with itemized
charges which include the billing code for LEQEMBI. Eligible patients who
participate in the Program may pay as little as $0 out-of-pocket per date of
treatment. Eisai Inc. will pay up to $10,000 per calendar year toward an
eligible patient's out-of-pocket costs for LEQEMBI, including deductibles,
copays and coinsurances. Depending on the patient's insurance plan, patient
could have additional financial liability for any amounts over Eisai's maximum
benefit. The offer is not valid for any other out-of-pocket costs, including
medical administration charges. Supporting documentation must be
submitted to the LEQEMBI Copay Assistance Program within 365 days of the
date of treatment or the request will be rejected. In order to be eligible for
reimbursement under LEQEMBI Copay Assistance Program, claims for
LEQEMBI must be submitted by provider to patient's private health insurance
separately from other services and products. Additional instructions regarding
required documentation in support of each claim will be provided by the
program following confirmation of eligibility and enrollment. The LEQEMBI
Copay Assistance Program will process eligible claims for patient out-of-
pocket costs for LEQEMBI incurred for product administered up to 180 days
prior to the date the patient is enrolled in the program.

Upon enrollment in the program, each patient will be issued a 16-digit virtual
debit card. By enrolling in this program, the patient is providing consent for
the LEQEMBI Copay Assistance Program to provide payment information for
any approved claims, in the form of the 16-digit virtual debit card number,
directly to the provider or alternate site of care identified on this enrollment
form to be applied directly to the patient's out-of-pocket costs for LEQEMBI.
By enrolling in the program and accepting payment, provider agrees to put
the value of the patient LEQEMBI Copay Assistance Program directly toward
the patient's out-of-pocket costs for LEQEMBI only. If provider has already
received payment from the patient for the patient's out-of-pocket cost for
LEQEMBI covered by the program, provider agrees to refund the amounts
received back to the patient.

Patient and provider agree not to seek reimbursement for any or all of the
benefit received by the patient through the LEQEMBI Copay Assistance
Program. Patients and providers are responsible for complying with all
requirements to disclose to insurance carriers and third-party payers the
benefit received from the LEQEMBI Copay Assistance Program. The offer may
not be combined with any other discount, coupon, free trial or offer. Federal
law prohibits the selling, purchasing, trading, or counterfeiting of this offer.
Void outside the USA and where prohibited by law. Eisai Inc. reserves the right
to rescind, revoke, or amend this offer at any time without notice. The value
of this offer is not contingent on any prior or future purchases. This offer is
solely intended to provide savings on the purchase of LEQEMBI. This offer
may not be accepted by all providers or alternate sites of care. The LEQEMBI
Copay Assistance Program is not an insurance program. No membership fees.
This offer will expire 12/31/2023.

The Temporary Supply Program (“TSP”) provides a temporary free supply of
up to 75 days of LEQEMBI for eligible, commercially insured patients awaiting
a coverage determination from their insurance provider for five or more
business days.

Temporary Supply Program terms and conditions

Patient must have a valid prescription for LEQEMBI for an FDA-approved
indication. Patient must have private, commercial insurance that provides
coverage for drugs through a medical benefit. The TSP is not available for
uninsured patients or patients enrolled in state and federal healthcare
programs, including Medicare, Medicaid, Medigap, VA, DoD, or TRICARE.
Patient must be 18 years or older. Patient must be a resident of, and product
must be administered in, the United States or Puerto Rico. Patient must meet
the financial eligibility criteria for enrollment in the Patient Assistance Program
for LEQEMBI in order to be eligible for the TSP.

In order to be eligible for the TSP, a patient’s prior authorization or appeal
determination for LEQEMBI must have been pending for 5 or more business
days, or if a prior authorization is denied, the patient's provider must pursue a
first-level appeal. If an enrolled patient’s prior authorization or appeal is subsequently
approved, patient will no longer be eligible to receive temporary supply of
LEQEMBI. In order for patient to continue to be eligible for the TSP, the
patient’s provider must agree to appropriately pursue insurance coverage for
the patient, including filing a first-level appeal of an initial coverage denial, if
appropriate, until a final coverage determination is made. Limit of one
enrollment (up to 75-day supply while coverage is pending) per patient per
lifetime. The TSP will ship each treatment of LEQEMBI directly to the provider
or alternate site of care identified on this enrollment form. Enrolled patients
will be evaluated for continued TSP eligibility prior to each shipment. By
accepting shipment, provider agrees to administer the temporary supply of
LEQEMBI only to the enrolled patient named in the materials accompanying
the shipment and to discard unused amounts in open vials. LEQEMBI provided
under this Program must be maintained separately from commercial
inventory. If the enrolled patient is no longer on therapy or otherwise cannot
use the temporary supply of LEQEMBI, provider agrees to promptly contact
the Eisai Patient Support Program to arrange for product return or disposal.

No patient, pharmacy, payor or other third-party may be billed for the
temporary supply of LEQEMBI. Patients and providers must not submit any
claim for reimbursement for product dispensed pursuant to the TSP to any
third-party payor, including Medicare, Medicaid, or any other federal or state
health care program. Patient cannot seek to have any part of the value of the
free product received through the TSP count towards any applicable out-of-pocket
spending calculations for drugs (eg, deductible or out-of-pocket cap).
The free LEQEMBI provided under the TSP is not contingent on any past or
future purchases of any product, under the patient’s insurance benefit or
otherwise. Eligibility determinations are made without regard to patient’s
commercial insurance provider, choice of physician or infusion provider.
Patients are free to change physicians or infusion providers at any time. The
TSP is not a health insurance, financial support, or cost savings program.
Limitations may apply. Eisai reserves the right to rescind, revoke, or amend
the TSP at any time without notice. Additional terms and conditions and
eligibility criteria apply. Contact the Eisai Patient Support Program for
additional information.

The LEQEMBI Patient Assistance Program is for patients who need help
paying for LEQEMBI. This program provides LEQEMBI at no cost to uninsured
and financially burdened patients who meet the program eligibility criteria.

Patient Assistance Program terms and conditions

The Patient Assistance Program (''Program'') provides free drug for eligible
patients who meet financial need and insurance coverage criteria. Patients
must have a valid prescription for LEQEMBI for an FDA-approved indication.
Patient must be either uninsured or insured but without insurance coverage
for LEQEMBI (ie, the insurer must have denied a first-level appeal of an initial
coverage denial) or without enough coverage to pay for LEQEMBI. Patient
must have a household income equal to or less than 500 percent of the
Federal Poverty Level. Patient must be 18 years or older. Patient must be a
resident of, and product must be administered in, the United States or Puerto
Rico. Commercially insured patients and Federal health care program
beneficiaries who qualify for the Program are enrolled for the entire calendar
year. Uninsured patients who qualify for the Program are enrolled for a rolling
12-month period. All patients must re-enroll at the end of their respective
Program approval period to ensure they continue to meet the Program's
eligibility criteria. Eisai reserves the right to reassess eligibility for patients
with commercial insurance during the enrollment period.

The Program will ship each dose of LEQEMBI directly to the provider or
infusion center identified in patient's enrollment form. By accepting shipment,
provider agrees to administer the free supply of LEQEMBI only to the enrolled
patient and to discard unused amounts in open vials. Product provided through
the Program may not be sold, traded, bartered, transferred, or returned for credit.
LEQEMBI provided under this Program must be maintained separately from
commercial inventory. If the enrolled patient is no longer on therapy or otherwise
cannot use the free supply of LEQEMBI, provider agrees to promptly contact
the Eisai Patient Support Program to arrange for product return or destruction.
If provider fails to meet any Program requirements, the Program will cease
sending any additional Program product to the provider until the provider
comes into compliance.

No patient, pharmacy, payor, or other third-party may be billed for the free
drug provided pursuant to the Program. Patients and providers must not
submit any claim for reimbursement for product pursuant to this Program to
any third-party payor, including Medicare, Medicaid, or any other federal or
state health care program. Patient cannot apply the value of the free product
received through this Program toward any insurance benefit out-of-pocket
spending calculations such as Medicare Part D True Out-of-Pocket Costs
(TrOOP). The free LEQEMBI provided under the Program is not contingent on
any past or future purchases of any product, under the patient's insurance
benefit or otherwise. Eligibility determinations are made without regard to
patient's insurance provider (if any), choice of physician or infusion provider.
Patients are free to change physicians or infusion providers at any time. The
Program is not health insurance. Limitations may apply. Eisai reserves the
right to rescind, revoke, or amend this Program at any time without notice.
Additional terms and eligibility criteria apply. Contact the Eisai Patient Support
Program for additional information.