A LIQUID HYDROCHLOROTHIAZIDE OPTION FOR APPROPRIATE ADULT AND PEDIATRIC PATIENTS TO TREAT

• HYPERTENSION, alone or in combination with other antihypertensives, to lower blood pressure
• EDEMA associated with congestive heart failure, hepatic cirrhosis and renal disease including nephrotic syndrome

SAVINGS OFFERED THROUGH OUR PREFERRED PHARMACY NETWORK*

Click here for a list of participating pharmacies
*Subject to eligibility requirements. See full terms and conditions below.

INZIRQO Patient Access Programs Terms & Conditions

Pay no more than $15 per month for eligible commercially insured or cash pay patients*

*Subject to eligibility requirements.

Brands Preferred Pharmacy Network: Available to eligible commercially insured patients only. Patients with government insurance are not eligible, including, but not limited to, patients with Medicare, Medicaid, Medigap, TriCare, VA, DoD, or any other federal-, state-, or government-funded healthcare program. The maximum financial assistance provided to eligible patients is $6,871 per calendar year. Cash-Discount Direct Program: Cash pay patients may pay no more than $15/month if eligible. Cannot be used in conjunction with Medicare, Medicaid or other federal or state programs. Patients must agree not to seek reimbursement through insurance including any federal or state program to participate in the Cash-Discount Direct Program.

*Full Terms and Conditions

ANI Pharmaceuticals, Inc. (ANI) has created a variety of options to help eligible patients have affordable access to their medication. Who’s eligible? Keep reading.

Federal or state‐funded programs, including but not limited to Medicaid, Medicare, Department of Veterans Affairs, Department of Defense, or TRICARE do not allow patients to receive any additional discount. Patients whose prescriptions are paid in part or in full by a federal or state-funded program, such as any of the programs listed above, or where otherwise prohibited by law, are not able to participate in either of the programs.

Brands Preferred Pharmacy Network: Eligible patients covered through commercial insurance may pay no more than $15 for a 30-day supply of INZIRQO at a participating pharmacy in the Brands Preferred Pharmacy Network. Savings are applied automatically at the point of sale. A list of pharmacies participating in the Network can be found at INZIRQO.com. If patients choose to utilize a pharmacy outside of the Brands Preferred Pharmacy Network, patients or pharmacists can acquire a copay savings card at INZIRQO.com to help reduce eligible patients’ copay to $15 for a 30-day supply of INZIRQO. The maximum financial assistance provided to eligible patients is $6,871 per calendar year.

Cash-Discount Direct Program: Any eligible patient with a valid prescription for INZIRQO may utilize the Cash-Discount Direct Program, which provides patients with access to INZIRQO for $15 for a 30-day supply. Patients must certify that they will not submit a claim for reimbursement for INZIRQO to any third-party payer, including, but not limited to, any state or federal program and that they will not include any amounts paid for Product in their True Out-of-Pocket (“TrOOP”) expenses. If seeking assistance for more than one calendar year, patients will be required to verify eligibility each calendar year.

The Brands Preferred Pharmacy Network and Cash-Pay Discount Programs are only available to patients residing in the U.S. (not including Puerto Rico or other U.S. territories).

The Brands Preferred Pharmacy Network and Cash-Pay Discount Programs are not health insurance.

These Programs cannot be combined with any other coupon, cash discount card, certificate, voucher, or similar offer.

ANI reserves the right to modify or cancel this program at any time.

Void if prohibited by law, taxed, or restricted.

For questions about these savings programs, contact ANI Customer Service at 1-800-434-1121.