Terms and conditions:

By using this Ozempic® Coupon, you attest that you meet the eligibility criteria, and you agree to comply with the terms and conditions described below every time that you use the offer:

Program eligibility requirements:

In order to redeem this offer, patient must have a valid prescription for the brand being filled. A valid Prescriber ID# is required on the prescription. Patients may only participate in this program if they have been prescribed Ozempic® for an FDA-approved indication within Ozempic's labeling. This offer operates outside of any third-party insurance and is not valid for prescriptions covered or submitted for reimbursement, in whole or in part, under Medicare, VA, DoD, Tricare, or similar federal or state programs, including any state pharmaceutical assistance program or commercial / private insurance. Medication filled prior to enrollment in this program will not be eligible for this coupon and cannot be reimbursed. Novo Nordisk's Eligibility and Restrictions, and Offer Details may change from time to time, and for the most recent version, please visit this webpage. Re-confirmation of patient information may be requested periodically to ensure accuracy of data and compliance with terms. Patients with questions about the Offer may call 1-833-378-3672.

By redeeming this coupon, you (and anyone else acting on your behalf) agree that:

• You must meet the requirements of the Ozempic® Self-pay offer every time you use this offer.

• You will not seek payment or accept reimbursement for any out-of-pocket costs for Ozempic® purchased with this offer from any insurance, including commercial insurance or any state, federal, or government healthcare programs (examples include but are not limited to Medicare, VA, DOD, TRICARE, Medicaid), healthcare reimbursement account, or any other third party payer, and you will not apply those costs toward any deductible or true out-of-pocket requirements. No primary, secondary, commercial, employer, government, or supplemental insurance may be used.

• If you have Medicare, Medicare Part D, a Medicare Advantage Prescription drug plan, or any other state or federal health insurance plan, you agree to the following:

◦ You will not ask your insurance to pay you back for the money that you self-paid for your medication using this offer.

◦ You will not attempt to count the cost of this medicine toward your insurance deductible or out-of-pocket limit.

◦ If you are asked by your insurance company about this prescription, you will tell your insurance company that you bought this medicine outside of its prescription plan using the Ozempic® self-pay offer and that you are not seeking reimbursement or submitting a claim for this prescription.

◦ The purchase of the prescription under this program is not conditioned on current or any future purchases of Ozempic® or any other items or services that could become billable to any Government Program.

This offer does not include all Novo Nordisk products. This offer is valid only in the United States and its territories, unless prohibited by law, and may be redeemed at participating pharmacies. Cannot be combined with any other external savings, free trial, or similar offer for the specified prescription. Data related to your redemption of the coupon may be collected, analyzed, and shared with Novo Nordisk for the purposes of administering and managing the program and other purposes related to assessing the program. Data shared with Novo Nordisk will be aggregated and de-identified and will not identify you.

This program is not health insurance. This program is administered by GoodRx on behalf of Novo Nordisk. Novo Nordisk reserves the right to rescind, revoke, or amend this offer without notice at any time.

Offer Details:

OZEMPIC® (semaglutide) injection 0.5 mg, 1 mg, or 2 mg: For a limited time, patients who are new to Ozempic® injection, can pay $199 for each monthly fill (1-box) of the Ozempic® pen that delivers 0.25 mg and 0.5 mg (NDC: 00169-4181-13). Available to new patients who have not used any other prior Ozempic® coupons. Offer only available for two monthly fills between November 17, 2025 – December 31, 2026. For each fill after, you will pay $349 per monthly supply of the Ozempic® pen that delivers 0.25 mg and 0.5 mg (NDC: 00169-4181-13) and the Ozempic® pen that delivers 1 mg (NDC: 00169-4130-13) and $499 per monthly fill of the Ozempic® pen that delivers 2 mg (NDC: 00169-4772-12). One month defined as 1 box of 1 Ozempic® pen. Novo Nordisk reserves the right to modify or cancel this program at any time.

Pharmacist:

• When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any Government Program for this prescription, or where prohibited by law. 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 eligibility criteria, and terms and conditions described herein.

• Submit to GoodRx as the primary claim using the BIN/PCN/GRP/ID found on the offer and with an Other Coverage Code 00 or 01. Collect the reduced out-of-pocket amount from the patient shown on the adjudicated claim.

• Please advise each eligible Medicare Part D or other applicable Government insured patient using the self-pay offer that they must not submit the purchase for inclusion in any insurance benefit out-of-pocket spending calculations, such as Medicare Part D True Out-of-Pocket Costs (TrOOP).

• Pharmacy must submit claim within 180 days from the date the prescription was filled. For any questions regarding processing, please call the Pharmacy Help Desk at 1-833-378-3672.