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INDICATION and IMPORTANT SAFETY INFORMATION
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INDICATION

AUVI-Q® (epinephrine injection, USP) is indicated in the emergency treatment of allergic reactions (Type I) including anaphylaxis to allergens, idiopathic and exercise-induced anaphylaxis. AUVI-Q is intended for patients with a history of anaphylactic reactions or who are at increased risk for anaphylaxis.

IMPORTANT SAFETY INFORMATION

AUVI-Q is intended for immediate self-administration as emergency supportive therapy only and is not a substitute for immediate medical care. In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care. Each AUVI-Q contains a single dose of epinephrine for single-use injection. More than two sequential doses of epinephrine should only be administered under direct medical supervision. Since the doses of epinephrine delivered from AUVI-Q are fixed, consider using other forms of injectable epinephrine if doses lower than 0.1 mg are deemed necessary.

AUVI-Q should ONLY be injected into the anterolateral aspect of the thigh. Do not inject intravenously, or into buttock, digits, hands, or feet. Instruct caregivers to hold the leg of young children and infants firmly in place and limit movement prior to and during injection to minimize the risk of injection-related injury.

Rare cases of serious skin and soft tissue infections have been reported following epinephrine injection. Advise patients to seek medical care if they develop any of the following symptoms at an injection site: redness that does not go away, swelling, tenderness, or the area feels warm to the touch.

Epinephrine should be administered with caution to patients with certain heart diseases, and in patients who are on medications that may sensitize the heart to arrhythmias, because it may precipitate or aggravate angina pectoris and produce ventricular arrhythmias. Arrhythmias, including fatal ventricular fibrillation, have been reported in patients with underlying cardiac disease or taking cardiac glycosides or diuretics. Patients with certain medical conditions or who take certain medications for allergies, depression, thyroid disorders, diabetes, and hypertension, may be at greater risk for adverse reactions. Common adverse reactions to epinephrine include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.

Please see the full Prescribing Information and the Patient Information.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

I am at least 18 years old and I authorize kaléo and its contractors to use, disclose, and/or transfer the personal information I supply (1) to contact me and provide me with informational and marketing materials and clinical trial opportunities related to my condition or treatment by any means of communication, including but not limited to text, e-mail, mail, or telephone; (2) to help kaléo improve, develop, and evaluate products, services, materials and programs related to my condition or treatment; (3) to enroll me in and provide me with AUVI-Q related programs and services that I may select or refuse at any time; (4) to disclose my enrollment and use of these services to my healthcare providers and insurers; and (5) to use my information that cannot identify me for scientific and market research.

To learn more about the kaléo Privacy Policy, click here.

To cancel or request a copy of this authorization, please contact us at 1-877-30-AUVIQ. I understand that if I cancel I may not be entitled to receive AUVI-Q related programs and services.

The health information contained herein is provided for general educational purposes only. Please consult with your healthcare professional if you have any questions about your health or treatment.

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PROCEED

kaléo Cares Patient Assistance Program

kaléo, the maker of AUVI-Q, understands the importance of having emergency medications available to patients. We also recognize that some patients may have financial difficulties that prevent them from obtaining these needed medications.

Through the kaléo Cares Patient Assistance Program, patients who are experiencing financial difficulties may be able to receive AUVI-Q at no cost.

To be eligible for assistance, a patient must:

Patients who are eligible for Medicaid coverage may be eligible for assistance to receive AUVI-Q at no cost.

PATIENT ASSISTANCE FORM

INDICATION
AUVI-Q® (epinephrine injection, USP) is indicated in the emergency treatment of allergic reactions (Type I) including anaphylaxis to allergens, idiopathic and exercise-induced anaphylaxis. AUVI-Q is intended for patients with a history of anaphylactic reactions or who are at increased risk for anaphylaxis.

IMPORTANT SAFETY INFORMATION
AUVI-Q is intended for immediate self-administration as emergency supportive therapy only and is not a substitute for immediate medical care. In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care. Each AUVI-Q contains a single dose of epinephrine for single-use injection. More than two sequential doses of epinephrine should only be administered under direct medical supervision. Since the doses of epinephrine delivered from AUVI-Q are fixed, consider using other forms of injectable epinephrine if doses lower than 0.1 mg are deemed necessary.

AUVI-Q should ONLY be injected into the anterolateral aspect of the thigh. Do not inject intravenously, or into buttock, digits, hands, or feet. Instruct caregivers to hold the leg of young children and infants firmly in place and limit movement prior to and during injection to minimize the risk of injection-related injury.

Rare cases of serious skin and soft tissue infections have been reported following epinephrine injection. Advise patients to seek medical care if they develop any of the following symptoms at an injection site: redness that does not go away, swelling, tenderness, or the area feels warm to the touch.

Epinephrine should be administered with caution to patients with certain heart diseases, and in patients who are on medications that may sensitize the heart to arrhythmias, because it may precipitate or aggravate angina pectoris and produce ventricular arrhythmias. Arrhythmias, including fatal ventricular fibrillation, have been reported in patients with underlying cardiac disease or taking cardiac glycosides or diuretics. Patients with certain medical conditions or who take certain medications for allergies, depression, thyroid disorders, diabetes, and hypertension, may be at greater risk for adverse reactions. Common adverse reactions to epinephrine include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.

Please see the full Prescribing Information and the Patient Information.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Pricing Philosophy for AUVI-Q® (epinephrine injection, USP)

As a company founded by patients with life-threatening allergies, we take our commitment to the needs of patients and their families very seriously. In this era of high deductible health plans, many patients find it harder than ever to afford their medications. We are committed to ensuring thatpatients with commercial insurance, or those facing financial hardship, should be able to obtain our potentially lifesaving products for little to no out-of-pocket cost.

Our Beliefs:
For us, the patient always comes first. We believe the most important price is the price to the patient. We believe that patients with life-threatening conditions deserve fair access to the latest medicines that offer technological innovations that address their medical needs. We believe that when a healthcare practitioner prescribes AUVI-Q, patients should be able to fill their prescription without high out-of-pocket costs.

Our Commitment to Access and Affordability:
We have seen firsthand in this current healthcare system the very real challenges patients are facing in being able to access and afford potentially lifesaving medicines. Similar to our product innovation process, our AUVI-Q patient access program has been built to solve for some of these challenges and help focus on what matters most... access and affordability to AUVI-Q for patients.

Our Commitment to AUVI-Q Manufacturing and Quality:
Kaléo is committed to the highest standards of product and manufacturing quality. Final manufacturing and assembly of AUVI-Q is conducted in the United States on a 100% automated robotic production line with more than 100 automated quality checks on each and every product.

Patients can be confident in our approach to design quality into AUVI-Q and incorporate quality into every aspect of the manufacturing process.

References

Terms and Conditions

Only valid for commercially insured patients in the 50 United States and DC through the direct delivery service and/or designated retail pharmacies. Not eligible if prescriptions are paid for in part/full by state or federally funded program(s), like Medicare Part D, Medicaid, Vet. Aff., Dept. of Def., or Tricare, and where prohibited by law. OFFER IS NOT INSURANCE. Offer cannot be sold, purchased, traded, transferred, and cannot be combined with any other offer. Cash discount cards are not commercial payers and are not eligible to be used for this program. Offer provided by kaléo, and it may change at any time without notice.

Call 1-877-30-AUVIQ for questions regarding offer eligibility.

Thank you!

We look forward to staying in touch.

AUVI-Q® (epinephrine injection, USP) administers epinephrine in 3 steps.27