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THE BRAND NAMES INCLUDED ON THIS VOUCHER ARE PROPERTIES OF THEIR RESPECTIVE OWNERS. TERMS AND CONDITIONS: THIS OFFER
INVALID FOR PATIENTS WHOSE PRESCRIPTION CLAIMS FOR HUMALOG KWIKPEN, HUMALOG MIX75/25 KWIKPEN OR HUMALOG MIX50/50
KWIKPEN IS REIMBURSED BY (1) ANY GOVERNMENTAL PROGRAM, INCLUDING, WITHOUT LIMITATION, MEDICAID, MEDICARE, OR ANY OTHER
FEDERAL OR STATE PROGRAM SUCH AS CHAMPUS, THE VA OR A STATE PHARMACEUTICAL ASSISTANCE PROGRAM. PATIENT ACCEPTANCE OF
THIS OFFER MUST BE CONSISTENT WITH PATIENTS THIRD-PARTY PAYER CONTRACTS, IF ANY; AND PATIENTS MUST AGREE TO MEET ANY
REPORTING OBLIGATIONS. THIS OFFER IS ALSO INVALID WHERE PROHIBITED BY LAW, AND IS NOT AVAILABLE TO CLUBS AND GROUPS OR
ORGANIZATIONS. THIS OFFER EXPIRES DECEMBER 31, 2008. VOUCHER NOT VALID WITH ANY OTHER PROGRAM, DISCOUNT OR INCENTIVE
INVOLVING HUMALOG KWIKPEN, HUMALOG MIX75/25 KWIKPEN OR HUMALOG MIX50/50 KWIKPEN. OFFER GOOD FOR U.S. RESIDENTS ONLY.
VOID WHERE PROHIBITED BY LAW. PRODUCT DISPENSED PURSUANT TO TERMS OF THIS VOUCHER SHALL NOT BE SUBMITTED TO ANY
THIRD-PARTY PAYOR, PUBLIC OR PRIVATE (E.G., MEDICAID, MEDICARE, PRIVATE INSURANCE, OR OTHER HEALTHCARE PROGRAMS) FOR
REIMBURSEMENT. THIS OFFER MAY BE TERMINATED BY ELI LILLY AND COMPANY AT ANY TIME.
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