NOVO NORDISK INC.

Section 1: Program Description

1.1 The Novo Nordisk Alt Benefit Model Program. Novo Nordisk Inc. has established the Alternative Prescription Benefit Model Program (the "Novo Nordisk Program") to make covered Novo Nordisk prescription products 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 Novo Nordisk 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 Novo Nordisk Program covers Novo Nordisk prescription products designated by your health plan under its program configuration, which may include both injectable and oral tablet formulations. The specific products available under your health plan's program are available through your account at apalyrx.net. Product availability is subject to change based on Novo Nordisk's product portfolio and program terms. Oral tablet formulations are available upon commercial launch.

Section 2: Eligibility Requirements

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

2.2 Government Program Exclusion. You are not eligible for the Novo Nordisk Program if you are a beneficiary of any Government Program, including Medicare, Medicaid, TRICARE, the Veterans Administration Federal Supply Schedule, the 340B program, a Qualified Retiree Prescription Drug Plan, an Employer Group Waiver Plan, a Health Care Exchange plan, 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 Novo Nordisk Program pricing, you reaffirm that you are not a Government Program beneficiary.

2.3 Commercial Insurance Exclusion. The Novo Nordisk 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 Novo Nordisk Program pricing through the ApalyRx program.

2.4 United States Residents Only. The Novo Nordisk 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. Novo Nordisk products obtained through the program are for your own lawful personal use only. Resale, distribution, or transfer to any other person is strictly prohibited.

Section 3: Program Pricing and Benefit Design

3.1 Program Pricing Access. Novo Nordisk Program pricing is available to you only through the NovoCare Network Pharmacy designated 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 Prior Authorization Options. Your health plan may elect one of two program configurations:

• No Prior Authorization: Your health plan does not require prior authorization for your covered Novo Nordisk product, enabling access without prior authorization barriers related to age, BMI, co-morbidities, concurrent lifestyle modifications, timing of initiation, re-authorization, or lifetime caps.
• Prior Authorization to Label: Your health plan implements a prior authorization process based on the product label, which may include attestation of patient age and obesity or overweight status, specified authorization timing, and concurrent lifestyle modification requirements.

The configuration applicable to your health plan is determined by your employer. Apaly Health does not make benefit design or prior authorization determinations. Contact your employer or health plan administrator for information about which configuration applies to you.

3.3 No Lifetime Caps. No lifetime caps based on cost or length of therapy may be imposed on your access to covered Novo Nordisk products under the program.

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

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

Section 4: Fulfillment and Dispensing

4.1 NovoCare Network Pharmacy. Novo Nordisk Program pricing is available only when your prescription is dispensed by the NovoCare Network Pharmacy designated for the program through ApalyRx. Information about the designated dispensing pharmacy is available through your account at apalyrx.net.

4.2 Prescription Requirements. Each dispense under the Novo Nordisk 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 Maximum Quantity Limits. Dispensing under the Novo Nordisk Program is subject to maximum daily quantity limits established by Novo Nordisk for each covered product. Prescriptions exceeding applicable quantity limits may not be eligible for program pricing for the excess quantity.

4.4 Direct Shipment. Novo Nordisk Program products are shipped directly to your home address or another address you designate. Shipping is included at no additional cost. For injectable products, injection supplies are included with your shipment.

4.5 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, Novo Nordisk 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 Novo Nordisk products or to route prescriptions through the Novo Nordisk Program. Apaly Health and Novo Nordisk do not provide financial inducements to healthcare providers to prescribe Novo Nordisk products or to route prescriptions through the program. Your provider is not required to use any specific prescribing or de-prescribing protocol in connection with 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 Novo Nordisk Inc.

6.1 Data Required. Your participation in the Novo Nordisk Program requires the sharing of your health information with Novo Nordisk Inc. and its authorized agents as described in your HIPAA Authorization at apalyrx.com/legal. Novo Nordisk uses this information to administer the program, verify eligibility, validate program pricing claims, and satisfy compliance and reporting obligations under its agreement with Apaly Health.

6.2 De-identified Reporting. Apaly Health is required to provide Novo Nordisk Inc. with utilization and claims 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. De-identified information provided to Novo Nordisk will not be re-identified or combined with other data to identify you individually.

6.3 Patient Support Services. Novo Nordisk Inc. and its authorized agents may make available to you patient support services associated with the program. Participation in any such patient support services is voluntary.

Section 7: Program Changes

7.1 Novo Nordisk Program Modifications. Novo Nordisk Inc. may modify the program, including pricing tiers, covered products, designated dispensing pharmacies, and program requirements, at any time. Apaly Health will notify you of 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 Novo Nordisk Program. Contact your employer or health plan administrator for information about your benefit design.

7.3 Program Termination. If the Novo Nordisk 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 Novo Nordisk Program through the ApalyRx platform, you confirm the following:

• You have read and understand these Novo Nordisk 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 Novo Nordisk Program products are for your own personal use only
• You understand that Novo Nordisk Program pricing cannot be combined with additional Novo Nordisk assistance programs for the same medication
• You understand that program pricing is available only through the designated NovoCare Network Pharmacy
• You understand that your health information will be shared with Novo Nordisk Inc. and its agents as described in your HIPAA Authorization
• You understand that Novo Nordisk Inc. may modify or terminate the program at any time