By using the Lilly Insulin Lispro injection Vial Self-Pay Savings Card Program ("Program") and using the Lilly Insulin Lispro Vial Self-Pay Savings Card ("Card"), you attest that you meet the eligibility criteria, and you agree to comply with the terms and conditions described below:

Card Eligibility: (1.) You have been prescribed Insulin Lispro injection vial (10mL) consistent with FDA approved product labeling; (2.) You are not enrolled in any state, federal, or government funded healthcare program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medicare Advantage, Medigap, DoD, VA, TRICARE®/CHAMPUS, or any state prescription drug assistance program; (3.) You are a resident of the United States or a United States Territory (Puerto Rico, Guam, U.S. Virgin Islands, Northern Mariana Islands, American Samoa); and (4.) You are 18 years of age or older.

Card Terms and Conditions You must have a prescription for an approved use consistent with FDA-approved product labeling to pay as little as $35 for a 1-month prescription fill of your Insulin Lispro injection vial (10mL). One month is defined as 30-days. Card savings are subject to a maximum monthly savings based on wholesale acquisition cost minus self-pay price of $35 per prescription fill of each Insulin Lispro injection vial (10mL). Card may be used for a maximum of up to 13 prescription fills per calendar year for each Insulin Lispro injection vial (10mL). Subject to Lilly USA, LLC's ("Lilly") right to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly's sole discretion, without notice, and for any reason. Card expires and savings end on 12/31/2026.

Additional Program Terms and Conditions You understand and agree this Program and Card is for self-paying (cash) patients and operates outside of any health insurance program. You agree not to seek payment or accept reimbursement for any outofpocket costs for Insulin Lispro injection vials purchased with this Card, whether directly or indirectly, from any insurance plan, healthcare reimbursement account, or other thirdparty payer—including any state or federal healthcare program or private insurance—and you also agree not to apply those outofpocket costs toward your deductible or true outofpocket obligations. If you have an insurance plan that is participating in an alternate funding program or similar program ("AFP") that requires you to apply to the Lilly Insulin Lispro Vial Self-Pay Savings Card Program or otherwise pursue specialty drug prescription coverage through an alternate funding vendor as a condition of, requirement for, or prerequisite to coverage of your Insulin Lispro injection vial (10mL), you are not eligible for and are prohibited from using the Lilly Insulin Lispro Vial Self-Pay Savings Card Program. AFPs include programs where coverage, reimbursement, or patient out of pocket costs for a product in some way vary based on the availability of a manufacturer co-pay or other financial assistance programs. AFPs may modify, delay, deny, restrict, or withhold insurance benefits or coverage from patients, or exclude Lilly products from coverage contingent upon a member's use of Lilly Insulin Lispro Vial Self-Pay Savings Card Program. You agree to inform Lilly Insulin Lispro Vial Self-Pay Savings Card Program if you are or become a member of such an alternative funding program. At its sole discretion and with or without notice, Lilly may reduce, eliminate, or otherwise modify the Card savings for any reason including but not limited to if your commercial drug insurance plan removes coverage for your Insulin Lispro injection vial (10mL) and/or requires you to utilize the Card). You are responsible for any applicable taxes, fees, and any amount that exceeds the monthly or annual maximum Card savings. Monthly and annual maximum savings are set at Lilly's sole and absolute discretion and may be changed with or without notice at any time for any reason. You must meet the Card eligibility criteria, terms and conditions every time you use the Card. If at any time you begin receiving drug coverage under any state, federal, or government funded healthcare program, you understand that you will no longer be eligible for the Lilly Insulin Lispro Vial Self-Pay Savings Card and agree to call the Lilly Insulin Lispro Vial Self-Pay Savings Card Program at 1-866-923-1953 to stop participation. Card activation is required. Card savings cannot be combined or utilized with any other program, discount, discount card, cash discount card, coupon, incentive, or similar offer involving your Insulin Lispro injection vial (10mL). You agree that this Card savings is intended solely for the benefit of you, the patient, and that the Card benefits are non-transferable. It is prohibited for any person to sell, purchase, or trade; or to offer to sell, purchase, or trade, or to counterfeit the Card. THIS CARD IS NOT INSURANCE. Lilly has the sole right to interpret and apply Card eligibility criteria, and terms and conditions. Card eligibility, and terms and conditions may be terminated, rescinded, revoked, or amended by Lilly at any time without notice and for any reason. Lilly's sole discretion to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions includes the right to terminate any individual Card if Lilly determines, in its sole discretion, that a patient does not satisfy the Card's eligibility criteria or is using or has attempted to use the Card inconsistently with these terms and conditions. Eligibility criteria, and terms and conditions for the Lilly Insulin Lispro Vial Self-Pay Savings Card Program may change from time to time. You may be required to obtain a new Card, including if any Card terms and conditions have been terminated, rescinded, revoked, or amended by Lilly. Card void where prohibited by law. Subject to Lilly's right to terminate, rescind, revoke or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly's sole discretion, without notice, and for any reason. The Card expires and savings end on 12/31/2026.