LILLY USA, LLC

Section 1: Program Description

1.1 The Lilly OMM Carve-Out Program. Lilly USA, LLC, an affiliate of Eli Lilly and Company, has established the Obesity Management Medicines Carve-Out Program (the "Lilly OMM Program") to make covered obesity management medicines available at contracted pricing to eligible members of employer-sponsored health plans that have elected to participate in the program through Apaly Health Inc.

1.2 Apaly Health Role. Apaly Health Inc. administers the Lilly OMM Program on behalf of participating employer health plans. Apaly Health is not a party to the clinical relationship between you and your prescribing provider and does not make clinical decisions regarding your treatment.

1.3 Covered Products. The Lilly OMM Program covers Lilly obesity management medicines designated by your health plan under its program configuration. The specific products and current pricing available under your health plan's program are available through your account at apalyrx.net. Product availability and pricing are subject to change based on Lilly's product portfolio and program terms.

Section 2: Eligibility Requirements

2.1 Health Plan Coverage Required. To access Lilly OMM Program pricing, your health plan must have adopted a benefit design that includes coverage for the applicable Lilly obesity management medicine and has contracted with Apaly Health Inc. to provide access to the Lilly OMM Program.

2.2 Government Program Exclusion. You are not eligible for the Lilly OMM Program if you are a beneficiary of any Government Program, including Medicare, Medicaid, TRICARE, the Veterans Administration Federal Supply Schedule, the 340B program, or any other federal or state health care program. This exclusion applies regardless of whether the Government Program is your primary or secondary coverage. By accessing Lilly OMM Program pricing, you reaffirm that you are not a Government Program beneficiary.

2.3 Commercial Insurance Exclusion. The Lilly OMM Program is designed for self-funded employer health plan members accessing the program through a direct employer benefit. Members who are also seeking to use commercial health insurance benefits for the same prescription are not eligible for Lilly OMM Program pricing through the ApalyRx program.

2.4 United States Residents Only. The Lilly OMM Program is available only to members residing in the United States, its territories, and the District of Columbia, where the designated Dispensing Pharmacy is licensed to fulfill prescriptions.

2.5 Own Use. Lilly products obtained through the OMM Program are for your own lawful personal use only. Resale, distribution, or transfer to any other person is strictly prohibited and constitutes a material violation of your program participation terms.

Section 3: Program Pricing and Benefit Design

3.1 Program Pricing Access. Lilly OMM Program pricing is available to you only through the designated Dispensing Pharmacy for the program. Your health plan determines which pricing tier applies based on its benefit design configuration. Pricing is made available to you and your health plan transparently as part of the ApalyRx program.

3.2 No Additional Lilly Assistance Programs. If you are accessing Lilly products at Lilly OMM Program pricing through the ApalyRx program, you are not eligible for any additional Lilly-sponsored assistance, discount, or support programs for the same medication during the same period. Additional programs that cannot be combined with Lilly OMM Program pricing include copayment assistance programs, eVoucher programs, patient assistance programs, and any other Lilly-sponsored discount or financial assistance program for the same product.

3.3 No Government Program Claims. You may not submit, and may not permit any other person to submit, any claim for Lilly products dispensed under the OMM Program to any Government Program. Amounts paid by you or your health plan under the Lilly OMM Program do not count toward any Government Program deductible or out-of-pocket maximum.

Section 4: Fulfillment and Dispensing

4.1 Designated Dispensing Pharmacy. Lilly OMM Program pricing is available only when your prescription is dispensed by the Dispensing Pharmacy designated for the Lilly OMM Program. Information about the designated Dispensing Pharmacy for the Lilly OMM Program is available through your account at apalyrx.net.

4.2 Prescription Requirements. Each dispense under the Lilly OMM Program requires a valid prescription from a licensed prescriber and a new patient request. Automatic refills are not permitted. You will be notified via SMS when a new request is needed.

4.3 Direct Shipment. Lilly OMM Program products are shipped directly to your home address or another address you designate. Shipping and injection supplies are included at no additional cost.

4.4 Pharmacy of Choice. You retain the right to request transfer of your prescription to a pharmacy of your choice at any time. If you exercise this right, Lilly OMM Program pricing will not be available for that prescription and standard plan benefit pricing will apply.

Section 5: Clinical Independence

5.1 Prescriber Independence. Your prescribing provider retains full clinical independence and is not required to prescribe Lilly products or to route prescriptions through the Lilly OMM Program. Apaly Health and Lilly USA, LLC do not provide financial inducements to healthcare providers to prescribe Lilly products or to route prescriptions through the program.

5.2 No Clinical Advice. Nothing in these terms or in any communication from Apaly Health or ApalyRx LLC constitutes medical advice, a recommendation regarding your treatment, or an endorsement of any specific medication. All treatment decisions are made solely by you and your provider.

Section 6: Data Sharing with Lilly USA, LLC

6.1 Data Required. Your participation in the Lilly OMM Program requires the sharing of your health information with Lilly USA, LLC and its authorized agents as described in your HIPAA Authorization at apalyrx.com/legal. Lilly uses this information to administer the OMM Program, verify eligibility, facilitate patient support services, and satisfy compliance and reporting obligations under its agreement with Apaly Health.

6.2 Patient Support Services. Lilly USA, LLC and its authorized agents may use your information to make available to you patient support services associated with the Lilly OMM Program, which may include disease management support, reimbursement assistance information, adherence programs, and nurse educator services. Participation in these patient support services is voluntary.

6.3 Reporting. Apaly Health is required to provide Lilly USA, LLC with utilization and eligibility reporting information as part of program administration. Such reporting is conducted using de-identified or appropriately authorized information consistent with your HIPAA Authorization and applicable law.

Section 7: Program Changes

7.1 Lilly Program Modifications. Lilly USA, LLC may modify the OMM Program, including pricing, covered products, designated dispensing pharmacies, and program requirements, at any time. Apaly Health will notify you of any changes that affect your active prescriptions.

7.2 Benefit Design Changes. Your health plan may modify its benefit design configuration affecting your access to the Lilly OMM Program. Contact your employer or health plan administrator for information about your benefit design.

7.3 Program Termination. If the Lilly OMM Program is terminated, Apaly Health will notify you and transfer your active prescriptions to available program channels or standard benefit channels.

Section 8: Member Acknowledgments

By accessing the Lilly OMM Program through the ApalyRx platform, you confirm the following:

• You have read and understand these Lilly Member Program Terms
• You understand that participation is voluntary and that you may obtain your medications through standard channels at any time
• You represent that you are not a beneficiary of any Government Program
• You represent that you are not seeking to use commercial health insurance for the same prescription
• You understand that Lilly OMM Program products are for your own personal use only
• You understand that Lilly OMM Program pricing cannot be combined with additional Lilly assistance programs for the same medication
• You understand that program pricing is available only through the designated Dispensing Pharmacy
• You understand that your health information will be shared with Lilly USA, LLC and its agents as described in your HIPAA Authorization
• You understand that Lilly USA, LLC may modify or terminate the program at any time