Karyopharm KaryForward Patient Support Services

Karyopharm Therapeutics offers comprehensive patient support services through its KaryForward program to facilitate access to Karyopharm’s oncology medication, Xpovio, including reimbursement support and patient financial assistance (Table).

KaryForward Patient Support Services

KaryForward offers patients a comprehensive set of support services, including financial assistance for patients, such as copay support; reimbursement support, such as insurance benefit investigation, prior authorization, and/or appeal assistance; and patient and caregiver resources, such as support from a dedicated Nurse Case Manager regarding prescription instructions and medication side effects.

Xpovio Copay Program

The Xpovio Copay Program provides copay assistance to eligible patients with commercial insurance. Eligible patients may pay as little as $5 per month out of pocket for Xpovio, with a maximum amount of $8000 per month and an annual cap of $25,000.

To be eligible for the Xpovio Copay Program, patients must:

• Be a resident of the United States or US territories
• Have commercial insurance that covers Xpovio
• Have a valid prescription for an FDA-approved indication for Xpovio
• Not be participating in any federal or state healthcare programs, including Medicare, Medicaid, TRICARE, and Veterans Health Administration.

The Xpovio Copay Program is not valid for patients who are paying cash for Xpovio, when Xpovio is not covered by the patient’s commercial insurance, or when the patient’s plan reimburses the entire cost of Xpovio.

KaryForward Patient Assistance Program

The KaryForward Patient Assistance Program provides Xpovio free of charge to uninsured and underinsured patients who meet the requirement criteria.

If patients do not meet the eligibility criteria listed above and still need assistance, KaryForward may assist in identifying alternate sources of coverage.

QuickStart Program

The QuickStart Program is available to eligible patients who are receiving their first prescription of Xpovio and cannot establish coverage or verification of coverage within 5 business days.

To be eligible for the QuickStart Program, patients must:

• Have received their first Xpovio prescription
• Not be able to ascertain coverage or verification of coverage within 5 business days
• Be enrolled in the KaryForward support services program.

Call 877-527-9493 for further details about the QuickStart Program.

Bridge Program

The Bridge Program enables the prescriber to provide eligible patients with an emergency supply of a Karyopharm medication at no cost if the patient has an unexpected disruption in therapy of more than 5 business days, and if the provider determines that it is medically necessary for the patient to continue therapy without interruption.

Dose Exchange Program

This new program offers support for patients who may need a dose adjustment mid-cycle. Please see the Dose Exchange Form for more details, terms and conditions, and to enroll your appropriate patients.

Application & Enrollment

Enrollment in the Xpovio Copay Program, KaryForward Patient Assistance Program, QuickStart Program, and the Bridge Program requires the completion and submission of the KaryForward Enrollment Form. The completed enrollment form should be faxed to 833-589-1603. The type(s) of patient support services needed must be indicated on the form, and the patient and the prescribing physician are required to sign the application. Assistance with the enrollment process can be obtained by calling 877-527-9493.

Xpovio is dispensed through a specialty pharmacy. Xpovio may be sent to the preferred specialty pharmacy indicated on the enrollment form or to the patient’s home.

TABLE Karyopharm Therapeutics Oncology Drug