INPATIENT HOSPITAL PHARMACY FREE TRIAL PROGRAM

THE INPATIENT HOSPITAL PHARMACY FREE TRIAL PROGRAM

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Please see below for an overview of the program rules for the INVEGA SUSTENNA^® Inpatient Hospital Pharmacy Free Trial Program. In order to receive free trial units for your patients, you must agree and adhere to all program rules, which can be found on the website upon login.

ELIGIBILITY

The free trial product requested must be for an inpatient hospital licensed as a hospital under applicable state law that is unable to accept PDMA samples. Pharmacy agrees that in its capacity as a pharmacy of a healthcare entity,¹ it would be eligible to receive samples under PDMA, even if it elects not to do so as a matter of pharmacy or inpatient hospital policy. Retail pharmacies are not eligible for program participation. Participating pharmacist(s), pharmacy(ies), hospital(s), and prescriber(s) must be licensed or authorized under state law to dispense and/or prescribe the prescription drug product requested. There is no requirement for subsequent use of INVEGA SUSTENNA^® for any patient receiving a free trial unit.

ANNUAL ENROLLMENTS

Enrollments must minimally include one of each of the following valid² state license numbers: (1) inpatient hospital pharmacist, (2) inpatient hospital pharmacy, (3) inpatient hospital, and (4) inpatient hospital prescriber.³ If there is a change to any of the information provided, you are required to notify us immediately.

PATIENT & PRESCRIBER QUANTITY LIMITS

For patients determined to be appropriate, pharmacists may order and receive up to 2 free trial units per calendar year per patient. Orders will ship directly to the hospital pharmacy. Additional quantity limits are up to 96 units per prescriber and no more than 480 units per institution, each within a 6-month period. Inpatient hospital pharmacies and inpatient hospitals must have the ability to track utilization of this program by each patient and establish adequate controls to ensure that product received under this program is appropriately segregated and tracked as if it were a PDMA sample. Janssen Pharmaceuticals, Inc., reserves the right to audit these controls.

PROHIBITION ON SEPARATE BILLING

This product is being provided free of charge. Free trial units are commercially labeled as trade products and not labeled as sample products. Do not separately bill the patient, the patient's insurance carrier, or the government for any INVEGA SUSTENNA^® dispensed as part of this program. Free trial product received pursuant to this program may not be sold, traded, bartered, or returned for credit.

EXCLUSIONS

The program is only available for an inpatient hospital that is unable to accept PDMA samples. The inpatient hospital agrees that it is not utilizing samples. If samples and free trial units are being shipped to the same address, the inpatient hospital must be able to provide a distinct location (floor, suite, office) for shipment of samples within the hospital for outpatient use.

DISPENSE DATE

Orders requesting free trial units must be submitted within 30 days of the dispense date. The dispense date may not be in the future. The initial request for a free trial unit must be based on a unit taken from inventory or purchased by the pharmacy.

SERIAL NUMBER

The package serial number and lot number for the INVEGA SUSTENNA^® medication is required each time an order is placed. The serial and lot number of a recently dispensed product is required. The serial number and lot number are found on the bottom of the carton of the medication. If a serial number and lot number is not entered, the order cannot be processed. If a duplicated serial number is entered, the order will be rejected.

PHARMACIST ACKNOWLEDGMENT OF RECEIPT (AOR)

Failure to complete AOR(s) within ninety (90) days will result in a suspension of the program for the pharmacist, pharmacy, and hospital.

HOSPITAL VERIFICATION LETTER (HVL)

For hospitals that do not have an on-site owned and operated pharmacy, the hospital may receive free trial units for its patients through an off-site pharmacy owned by the hospital or pharmacy operated by a third party on behalf of the hospital, if the hospital designates the pharmacy and the pharmacy provides the required certification. Twice a year, hospitals receiving free trial units from a pharmacy that is not on-site owned and operated by the hospital will be required to acknowledge their receipt of the free trial units requested by the pharmacy, provide confirmation of a tracking mechanism, confirm only 2 units were dispensed per patient per year, and confirm compliance with program requirements.

ELECTRONIC SIGNATURE & SECURITY

You agree that you are creating an electronic signature, and that this electronic signature is the legal and binding equivalent of your handwritten signature. Precautions to safeguard your email account against unauthorized access, disclosure, alteration, and destruction must be taken. Password and security answers must be confidential, and all information provided must be true.

TRANSPARENCY

Hospital, pharmacy, pharmacist, and prescriber information and the free trial disbursement(s) that you receive may be reported as required by state or federal law. Once reported, this information may be made available for public view.

PRIVACY POLICY

By providing your information, you are requesting to register your participation in the INVEGA SUSTENNA^® Inpatient Hospital Pharmacy Free Trial Program, where your information will be used to satisfy this purpose and to fulfill any optional requests you may have indicated. Your information will be shared by Johnson & Johnson, with its affiliates and third parties involved in the INVEGA SUSTENNA^® Inpatient Hospital Pharmacy Free Trial Program. At any time, you can request to be removed from participating in the INVEGA SUSTENNA^® Inpatient Hospital Pharmacy Free Trial Program and any options you selected by calling 1-800-240-5746. All information you provide will be governed by our Privacy Policy, http://www.invegasustennahcp.com/privacy-policy. By providing us your information, you are acknowledging that you have read, understand, and agree to these conditions.

TERM AND SCOPE

Program terms expire at the end of each calendar year. Program available only in the United States and Puerto Rico.*^†

MENTAL HEALTH PRODUCTS, PROGRAMS, AND SERVICES

You may opt in to receive information about mental health products, programs, and services from Janssen Pharmaceuticals, including information about INVEGA SUSTENNA^®.

*Janssen Pharmaceuticals, Inc., may terminate the program prior to the end of each calendar year, upon 60 days' notice to all participating inpatient pharmacies, or upon less or no notice if there is a change in interpretation of federal or stale laws supporting the continuation of the program.

^†Shipments will not be processed Friday through Sunday or on holidays. These factors may result in a delay in shipment. For questions about this program or if you no longer wish to participate, please call 800-240-5746, Monday through Friday, between 8 AM and 8 PM ET.

¹Healthcare entity means any person who provides diagnostic, medical, surgical, or dental treatment, or chronic or rehabilitative care, but does not include any retail pharmacy or any wholesale distributor. A person cannot simultaneously be a healthcare entity and a retail pharmacy or wholesale distributor.

²A valid state license (pharmacist, pharmacy, hospital) is registered with the state government as active and not expired.

³For prescribers, a valid state license indicates that the prescriber has prescriptive authority (MD, DO, NP, or PA). In addition, prescribers must have either a primary or secondary specialty as follows to participate: ADP, CHP, CPP, EFM, EM, EMS, GP, FM, FP, FPG, FPP, GP, GPM, HPF, HPI, HPM, HPN, IFP, IM, IMG, IPM, MN, MP, MPH, N, NRP, P, PFP, PH, PHA, HP, PSY, PYA, PYG, PYM, PYN; and have answered affirmatively the INVEGA SUSTENNA^® Qualifying the Customer initiative (QCI) question.