Important Safety Information Full Prescribing Information


In order to determine eligibility for the program, please answer the following questions.

1.Is the patient older than 18?

2.Does your patient live, or are you licensed in the state of Vermont?

3.Is the patient prescription paid for in whole or in part by Medicare, Medicaid, or Medicare Part D or any other Federal or State-government reimbursed prescription program?

4.Is the patient over 65 years of age?

Offer restrictions: May not be used to obtain prescription drugs paid for in part by Federal or State Healthcare Programs including Medicare, Medicaid, Medicare Advantage, Medicare Part D, Tricare, and VA. Not for use by VT residents, VT licensed medical professionals, patients under 18, where prohibited by law or patient's insurance plan, or where taxed or restricted. Maximum savings of $80 per month or $240 per 90 day supply. Eligible patients include those who participate in commercial insurance, through a healthcare exchange, or pay cash. Offer good through December 31, 2019.

Patient Instructions: In order to redeem this card you must have a valid prescription for VASCEPA (icosapent ethyl) and otherwise meet all eligibility criteria. Follow the dosage instructions given by the doctor. This card may not be redeemed for cash. Cardholders with questions, please call 1-855-497-8462.

Pharmacist Instructions for a Eligible Commercially Insured Patients: Submit the claim to the primary Third Party Payer first, then submit the balance due to Change Healthcare as a Secondary Payer COB [coordination of benefits] with patient responsibility amount and a valid Other Coverage Code, (e.g. 8). The patient is responsible for the first $9 and the card pays up to the next $80 on a monthly fill or $240 on a 90 day fill. Reimbursement will be received from Change Healthcare.

Pharmacist Instructions for a Cash-Paying Patient: Submit this claim to Change Healthcare. A valid Other Coverage Code (e.g. 1) is required. The patient is responsible for the first $9 and the card pays up to the next $80 on a monthly fill or $240 on a 90 day fill. Reimbursement will be received from Change Healthcare.

Valid Other Coverage Code required. For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-800-422-5604.

Program expires 12/31/2019. Program managed by ConnectiveRx on behalf of Amarin Pharma Inc. The parties reserve the right to rescind, revoke or amend this offer without notice at any time. Not valid if reproduced. Void where prohibited by law, taxed or restricted.

IMPORTANT SAFETY INFORMATION

What is VASCEPA?

VASCEPA is a prescription medicine used along with a low-fat and low-cholesterol diet to lower high levels of triglycerides (fats) in adults.

Who should not take VASCEPA?

What are the possible side effects of VASCEPA?

For more information, go to www.vascepa.com or call 1-855-VASCEPA (1-855-827-2372).