For Pharmacists

SAVINGS PROGRAM ELIGIBILITY CRITERIA AND FULL TERMS & CONDITIONS

*By using the CAPLYTA Savings Card, you acknowledge that you currently meet all Eligibility Criteria and Terms & Conditions and will comply with the terms & conditions below.

PROGRAM ELIGIBILITY CRITERIA AND TERMS & CONDITIONS:

This offer is valid for eligible new or existing patients who are filling a prescription for CAPLYTA.

Patients must be 18 years of age or older, residents of the United States or its territories where CAPLYTA is available, and have a valid prescription for CAPLYTA.

Patients must have private commercial insurance. Offer is not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, TRICARE, or other federal or state health programs (such as medical assistance programs). This offer is not insurance, has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, savings, or similar offer.

This savings card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs. You must deduct the value of this savings card from any reimbursement request submitted to your private insurance plan, either directly by you or on your behalf. You are responsible for reporting use of the savings card to any private commercial insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the savings card, as may be required. You should not use the savings card if your insurer or health plan prohibits use of manufacturer savings cards.

This offer is good only at participating retail pharmacies. This card may not be redeemed for cash. Void if prohibited by law, taxed, or restricted. Eligible patients may pay as little as $0 on the first two fills, up to the maximum lifetime benefit based on current list price of 30-day supply. On subsequent uses, eligible patients may pay as little as $0, up to the maximum benefit of $700 for a 30-day Rx; $1,400 for a 60-day Rx; and $2,100 for a 90-day Rx. Eligible, commercially insured patients who are taking CAPLYTA as an adjunctive or add-on treatment for Major Depressive Disorder may pay as little as $0 per prescription fill for a generic antidepressant with a maximum benefit of $100 per fill.

Program benefit calculated on FDA-approved dosing.

A valid Prescriber ID# is required on the prescription. Johnson & Johnson reserves the right to rescind, revoke, or amend this offer without notice at any time.

Data related to the redemption of this savings card may be collected, analyzed, and shared with Johnson & Johnson for market research and/or other purposes related to assessing the CAPLYTA Savings Program.

By using this offer, you authorize the CAPLYTA Savings Program to share your prescription information with CoverMyMeds so that CoverMyMeds may contact your healthcare provider to request submission of information to support coverage of your CAPLYTA prescription by your health insurance plan.

This program is valid through 12/31/2026.

No other purchase is necessary.

Johnson & Johnson reserves the right to rescind, revoke, or amend this offer without notice.

Patients with questions about the CAPLYTA Savings Card should call 1-800-639-4047.

Pharmacist: When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any federal, state, or other governmental programs for this prescription. This offer is valid only for patients with commercial insurance. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the terms & conditions described in the Restrictions section below.

Pharmacist instructions for a patient with an Eligible Third Party: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Change Healthcare as a Secondary Payer as a copay-only billing using a valid Other Coverage Code. Eligible patients may pay as little as $0 on the first two uses, up to the maximum lifetime benefit based on current list price of 30-day supply. On subsequent uses, eligible patients may pay as little as $0 up to the maximum benefit of $700 for a 30-day Rx; $1,400 for a 60-day Rx; and $2,100 for a 90-day Rx. Eligible, commercially insured patients who are taking CAPLYTA as an adjunctive or add-on treatment for Major Depressive Disorder may pay as little as $0 per prescription fill for a generic antidepressant with a maximum benefit of $100 per fill. Reimbursement will be received from Change Healthcare.

For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-800-433-4893.

Restictions: This offer is valid in the United States and its territories where CAPLYTA is available. Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, TRICARE, or other federal or state health programs (such as medical assistance programs). This offer is valid only for patients with commercial insurance. Cash Discount Cards and other non-insurance plans are not valid as primary under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payer of the existence and/or value of this offer. It is illegal to (or offer to) sell, purchase, or trade this offer. Program expires 12/31/2026. This offer is not transferable and is limited to one offer per person. Not valid if reproduced.

Void where prohibited by law. Program managed by ConnectiveRx on behalf of Johnson & Johnson.

Johnson & Johnson reserves the right to rescind, revoke, or amend this offer without notice at any time.