Patient access & support for CRYSVITA

^‡Kyowa Kirin Cares Patient Assistance Program Terms and Conditions The Kyowa Kirin Cares Patient Assistance Program (the “Program”) provides eligible patients with free Kyowa Kirin product from the date of approval into the Program through the end of the calendar year. Program eligibility is determined on a case-by-case basis, and patients must meet all of the following eligibility criteria to be considered for the Program:

• You must be a United States resident (including the United States territories) and reside in the US or its territories.
• You are being treated in an outpatient setting and have a valid prescription from a licensed U.S. healthcare professional.
• You are not receiving treatment in, or do not reside in, a clinic, hospital, nursing home, correctional facility, or a court-appointed program or facility.
• Your prescriber must certify in the submitted application that the requested product is prescribed for the Food and Drug Administration (FDA) approved indication.
• You must have no health or prescription drug coverage, or insurance coverage of any kind for CRYSVITA^® (burosumab-twza), or you have been denied CRYSVITA^® (burosumab-twza) coverage and have exhausted available appeals. You are not eligible for the Program if your employer, insurance plan, payor, or a third party administrator participates in an alternative funding program and requires you to apply to the Program as a condition of, requirement for, or prerequisite to coverage of relevant Kyowa Kirin products, or if your employer, insurance plan, payor, or a third party administrator otherwise denies, restricts, eliminates, delays, alters, or withholds any insurance benefits or coverage contingent upon application to, or approval or denial of eligibility for a manufacturer patient support program like the Kyowa Kirin Program. You are ineligible for assistance when an alternative funding plan obtains CRYSVITA^® through a non U.S. based distributor or outside the approved in-network distribution channels.
• Your annual household income must meet the Program financial criteria.
• You will be asked to submit documentation to validate levels of income (e.g., federal tax returns; IRS forms such as W-2 or 1099; Social Security statement; pay stubs, etc.).
• If you have no income, you will be required to provide a signed, notarized letter, stating the need for assistance.
• You and your prescriber may not bill, charge, seek credit for or otherwise submit any claim for reimbursement to any third-party payer for product provided through the Program.
• Participation in the PAP does not obligate you to use any specific health care provider, and you are free to change providers at any time.
• No product provided through the Program may be sold, traded, or returned for credit.
• The Program has the right to verify your eligibility, including the right to audit any information provided on the Program application form.
• If you have a change in insurance status or income, you must notify the Program immediately and acknowledge you may be deemed no longer eligible for the Program.
• The Program benefits, rules, and product availability are subject to change at any time without prior notification. Kyowa Kirin reserves the right to make eligibility determinations, to set Program parameters, to monitor participation, and to change, modify, or discontinue the Program at any time without notice.

The Program is NOT insurance, it is a “free goods” program which provides free Kyowa Kirin product only to qualifying enrollees.

A complete Program application that is signed by both the applicant and the prescribing healthcare provider is required for consideration for Program eligibility and enrollment. Approved patients will receive the requested Kyowa Kirin product free of charge from the date of Program approval through the end of the calendar year, after which time you must re-apply for continued assistance.

Program applications that reference or list an individual associated with, acting on behalf of, or a representative of, the applicant’s insurance company or payor as an alternate contact will be subject to additional review and will be denied. Also, Program applications that are completed or submitted at the direction of the applicant’s employer, insurance company or payor, or representative, or acting on behalf of the insurance company or payor, will be denied.

If enrolled in the Program, the requested Kyowa Kirin product will be shipped to you or your prescribing healthcare provider free of charge, so long as you have a legally valid prescription for the requested product and remain eligible for the Program during the entire enrollment period.

If you have any questions regarding the Program, your eligibility, or if you wish to discontinue your participation, please contact us at 833-KK-CARES Monday through Friday, 8AM to 8PM, Eastern Time (ET).

^§Data on File, January 2025. ^‖Data on File, May 2024.