By clicking “I Agree” below I authorize ASPN Pharmacies LLC (“ASPN”) to use and disclose my health information, including protected health information (“PHI”), to my healthcare provider (“HCP”) and the pharmacy that may fill my prescription (“Filling Pharmacy”) for purposes related to pharmacy services and healthcare. This includes activities necessary to obtain, transfer, and fulfill my prescription.

My authorization to permit the use and disclosure of my PHI will be effective on the date I click “I Agree” below and will expire in one year or the maximum period permitted by law if an expiration date of less than one year is required.

I understand that agreeing to this Authorization is voluntary and I have the right to revoke this Authorization, except to the extent ASPN has already used or disclosed my PHI in reliance on this Authorization. I understand that I may revoke my Authorization at any time by calling ASPN at 888-470-0391. I understand that my treatment, payment, enrollment, or eligibility for benefits will not be conditioned on whether I agree to this Authorization. I understand that the PHI used and disclosed pursuant to this Authorization may be subject to redisclosure by the recipient and may no longer be protected by state or federal privacy regulations. I may access a copy of this Authorization by calling ASPN at 888-470-0391.

If this Authorization is completed by a legal representative, the legal representative acknowledges the following:

The individual is a minor or legally incompetent or incapacitated
The legal representative has Legal authority as either a parent (not denied physical placement and parental rights have not been terminated by court order), legal guardian, next of kin/executor of deceased, or activated POA for health care

Please note, if this Authorization is completed by a legal representative certain of the data described above may not be PHI. However, in such instances, certain of the data described above may be the personal information of the legal representative and will be collected from the legal representative if this Authorization is Completed. Please see ASPN’s privacy policy for more information.

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Please read this policy carefully to understand our policies and practices regarding your Personal Information and how we will treat it. By accessing or using this Website, you acknowledge this privacy policy.

Effective Date: April 4, 2025

PURPOSE

This Notice of Privacy Practices (“Notice”) applies when ASPN Pharmacies LLC (“ASPN” or “we”) is using or disclosing your individually identifiable health information that we collect as a pharmacy subject to the Health Insurance Portability and Accountability Act (“HIPAA”). This means that this Notice applies when we use and disclose protected health information while we are providing pharmacy services. Protected health information (or “PHI”) is information that may identify you and that relates to your past, present, or future physical or mental health or condition, the provision of health care products and services to you or payment for such services. This Notice describes how we may use and disclose PHI about you, as well as how you obtain access to such PHI. This Notice also describes your rights with respect to your PHI. We are required by HIPAA to provide this Notice to you.

This Notice does not apply when ASPN or Asembia LLC collects or processes information for any purpose other than to provide you with pharmacy services. Find out more about how information not subject to this Notice is used and disclosed and your rights by visiting ASPN’s Privacy Policy.

We will abide by the terms of the Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. If we change this Notice, you can access the revised Notice on our website. Upon request, we will provide any revised Notice to you. Please check frequently for any changes to this Notice.

HOW WE USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

The following categories describe the ways that we may use and disclose your PHI without your written authorization. We have provided you with examples in certain categories. However, not every permissible use or disclosure will be listed in this Notice.

Treatment. We may use and disclose your PHI to provide and coordinate the treatment, medications, and services you receive. For example, we may disclose your PHI to physicians, pharmacies, or other health care providers who are involved in your care to coordinate or manage your health care services. This helps to coordinate your care and make sure that everyone who is involved in your care has the information that they need about you to meet your health care needs.

Payment. We may use and disclose your health information to obtain payment for services we provide. For example, we may inform your insurance company or pharmacy benefit manager to determine whether it will pay for health care products and services you need and to determine the amount of your cop-payment. We will bill you or a third-party payor for the cost of health care products and services we provide to you.

Health Care Operations. We may use and disclose your health information to conduct certain of our business activities, which are called health care operations. These uses and disclosures are necessary to run our business and make sure our patients receive quality care. For example, For example, we may use your PHI to monitor the performance of the staff and pharmacists providing treatment to you. We may use your PHI as part of our efforts to continually improve the quality and effectiveness of the health care products and services we provide. We may also analyze PHI to improve the quality and efficiency of health care, for example, to assess and improve outcomes for health care conditions. We may also disclose your PHI to other HIPAA covered entities that have provided services to you so that they can improve the quality and effectiveness of the health care services that they provide. We may use your PHI to create de-identified data, which is stripped of your identifiable data and no longer identifies you.

To Communicate with Individuals Involved in Your Care and Payment for Your Care. We may disclose to a family member, other relative, close personal friend, or any other person you identify, PHI directly relevant to that person's involvement in your care or payment related to your care. Additionally, we may disclose PHI to your "personal representative." If a person has the authority by law to make health care decisions for you, we will generally regard that person as your "personal representative" and treat them the same way we would treat you with respect to your PHI.

Notification. We may use or disclose your PHI to notify or assist in notifying a family member, personal representative, or another person responsible for your care, regarding your location and general condition.

Disaster Relief. We may use and disclose your PHI to organizations for purposes of disaster relief efforts.

Required by Law. We may disclose your health information when required to do so by federal, state, or local law.

Public Health Reporting. We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability, including the Food and Drug Administration. In certain circumstances, we may also report work-related illnesses and injuries to employers for workplace safety purposes.

Disaster Relief. We may use and disclose your PHI to organizations for purposes of disaster relief efforts.

Reporting Victims of Abuse or Neglect. We may disclose PHI to a government authority if we believe you have been the victim of abuse or neglect. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else.

Health Care Oversight. We may disclose your health information to authorities and agencies for oversight activities allowed by law, including audits, investigations, inspections, licensure and disciplinary actions, or civil, administrative, and criminal proceedings, as necessary for oversight of the pharmacy, government programs, and civil rights laws.

Legal Proceedings. We may disclose your health information in the course of certain administrative or judicial proceedings. For example, we may disclose your health information in response to a court order.

Law Enforcement. We may disclose your PHI for law enforcement purposes as required or permitted by law – for example, in response to a subpoena or court order, in response to a request from law enforcement, and to report limited information in certain circumstances.

Deceased Persons. We may disclose your health information to coroners, medical examiners, or funeral directors so that they can carry out their duties.

Organ and Tissue Donation. We may use and disclose your health information to organizations that handle procurement, transplantation, or banking of organs, eyes, or tissues.

Research. We may use your PHI to conduct research and for purposes preparatory to research, and we may disclose your PHI to researchers as authorized by law. For example, we may use or disclose your PHI as part of a research study when the research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your information.

To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Military and Veterans. If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.

Specialized Government Functions. In certain circumstances, HIPAA authorizes us to use or disclose your PHI to authorized federal officials for the conduct of national security activities and other specialized government functions.

Inmates. If you are or become an inmate of a correctional institution, we may disclose your PHI to the correctional institution or law enforcement official to assist them in providing you health care, protecting your health and safety or the health and safety of others, or providing for the safety of the correctional institution.

Fundraising. As permitted by applicable law, we may contact you to provide you with information about our fundraising programs. You have the right to "opt out" of receiving these communications and such fundraising materials will explain how you may request to opt out of future communications if you do not want us to contact you further for fundraising efforts.

Business Associates. We may contract with third parties to perform certain services for us, such as billing services, copy services or consulting services. These third-party service providers, referred to as Business Associates, may need to access your PHI to perform services for us. They are required by contract and law to protect your PHI and only use and disclose it as necessary to perform their services for us.

Note that some types of PHI, such as HIV information, genetic information, substance use disorder records, and mental health records may be subject to special confidentiality protections under applicable state or federal law and we will abide by those special protections. If you would like additional information about special state law protections, you may contact the Privacy Officer at the contact information below.

OTHER USES AND DISCLOSURES THAT REQUIRE YOUR PRIOR AUTHORIZATION

Specific Uses or Disclosures Requiring Authorization. We will obtain your written authorization for the use or disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of PHI, except in limited circumstances where applicable law allows such uses or disclosure without your authorization.

Other Uses and Disclosures. We will obtain your written authorization before using or disclosing your PHI for purposes other than those described in this Notice or otherwise permitted by law. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance on the authorization. To revoke an authorization, you must notify us in writing at the contact information below.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

This section describes your rights regarding the PHI we maintain about you. All requests or communications to us to exercise your rights discussed below must be submitted to our Privacy Officer in writing at the contact information below.

Right to Request Restrictions. You have the right to request additional restrictions on how our use or disclosure of your PHI by sending a written requested to the Privacy Officer at the contact information below. We are not required to agree to your requested restriction, unless that restriction is regarding disclosure of health information to your health plan and: (1) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and (2) the PHI pertains solely to a health care item or service for which you or another person (other than your health plan) paid for in full. If you do not want PHI sent to your health plan for payment for a prescription, talk to your pharmacist before your prescription is sent to the pharmacy.

Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain manner or at a certain location. For example, you may wish to receive information about your health status through a written letter sent to a private address. Please note if you choose to receive communications from us via e-mail or other electronic means, those may not be a secure means of communication and your PHI that may be contained in our e-mails to you will not be encrypted. This means that there is risk that your PHI in the e-mails may be intercepted and read by, or disclosed to, unauthorized third parties. To request confidential communication of your PHI, you must submit a request in writing to the Privacy Officer. Your request must tell us how or where you would like to be contacted. We will accommodate reasonable requests. However, if we are unable to contact you using the ways or locations you have requested, we may contact you using the information we have.

Right to Inspect and Copy. With few exceptions, you have the right to inspect and receive a copy of your PHI that we maintain about you. If we maintain an electronic designated record set containing your PHI, you have the right to request to obtain the PHI in an electronic format if it is readily producible. To inspect or obtain a copy of your PHI, you must send a written request to the Privacy Officer. You may ask us to send a copy of your PHI to other individuals or entities that you designate in writing if it clearly designates the recipient and location for delivery. We may charge you a fee as authorized by law to meet your request.

We may deny your request to inspect and copy your PHI in certain limited circumstances. If you are denied access to your PHI, you have the right in certain cases to request that the denial be reviewed.

Right to Request Amendment. If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. For example, if your date of birth is incorrect, you may request that the information be corrected. To request a correction or amendment, you must make your request in writing and provide a reason for your request. If your request is denied, we will provide you with information about why we denied it.

Right to an Accounting of Disclosures. With the exception of certain disclosures, you have a right to receive a list of the disclosures we have made of your PHI in the six years prior to the date of your request, to entities or individuals other than you. You will not be charged for this accounting, unless you request more than one accounting per year, in which case we may charge you a reasonable cost-based fee for providing the additional accounting(s). We will notify you of the costs involved and give you an opportunity to withdraw or modify your request before any costs have been incurred.

Right to a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice at any time, even if you previously agreed to receive this Notice electronically. You may request we mail you a paper copy of this Notice by contacting our Privacy Officer in writing at the contact information below. A copy of this Notice is also available at our website.

Notification of a Breach. You have a right to be notified following a reportable breach of your unsecured PHI, and we will notify you in accordance with applicable law.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have questions or would like additional information about our privacy practices, you may contact our Privacy Officer by mail at

Asembia, Inc.

Attn: ASPN Privacy Officer

200 Park Ave. Suite 300

Florham Park, NJ 07932

or by email or at: ComplianceReview@asembia.com.

If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or otherwise retaliated against for filing a complaint.

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Effective Date: April 4, 2025

PURPOSE

HOW WE USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

Disaster Relief. We may use and disclose your PHI to organizations for purposes of disaster relief efforts.

Required by Law. We may disclose your health information when required to do so by federal, state, or local law.

Disaster Relief. We may use and disclose your PHI to organizations for purposes of disaster relief efforts.

Deceased Persons. We may disclose your health information to coroners, medical examiners, or funeral directors so that they can carry out their duties.

Organ and Tissue Donation. We may use and disclose your health information to organizations that handle procurement, transplantation, or banking of organs, eyes, or tissues.

OTHER USES AND DISCLSOURES THAT REQUIRE YOUR PRIOR AUTHORIZATION

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

Notification of a Breach. You have a right to be notified following a reportable breach of your unsecured PHI, and we will notify you in accordance with applicable law.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have questions or would like additional information about our privacy practices, you may contact our Privacy Officer by mail at

Asembia, Inc.

Attn: ASPN Privacy Officer

200 Park Ave. Suite 300

Florham Park, NJ 07932

or by email or at: ComplianceReview@asembia.com.

Another option is now available. Provide your information so your doctor can submit a prescription for COSENTYX® (secukinumab) through ASPN Pharmacies.

COSENTYX is now available through a direct-to-patient platform to those without coverage or who choose to pay out of pocket for the full cost of their prescriptions. The price is $3,434 per self-injectable dose. That's a savings of 55% off the list price.

Please note: This self-pay option does not involve your insurance. By proceeding, you acknowledge that you will not be able to submit a claim to your insurance provider for this product at any point in the future.

Patients: Get Started

If you and your provider have decided COSENTYX is right for you, ASPN Pharmacies can help get prescriptions directly from providers. Please fill out the information below and a customer service representative will contact your provider directly, and follow up with you to discuss next steps.

By completing the information below, you will be sharing your information with ASPN Pharmacies.

* I can confirm that COSENTYX has been prescribed to me by my current healthcare provider, whose details I have listed below.

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Provider Information

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*Authorize data sharing with ASPN. ASPN may need to reach out to your doctor to process your prescription. Please read the and accept or decline to indicate your signature.
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*By providing your cell phone number, you are agreeing that ASPN Pharmacies will send you pharmacy and healthcare-related text messages via an automatic telephone dialing system. For more information, please see the
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Novartis Terms & Conditions:
This Direct Purchase Option to self-pay patients facilitates cash purchases of certain Novartis products to individuals with a valid prescription for the Novartis product being filled. The Direct Purchase Option is not insurance and – as an exclusive cash-pay offer – insurance is not accepted. Neither Novartis nor the Direct Purchase Option are pharmacies; all purchases are made through ASPN Pharmacies LLC and prescription will be fulfilled through Thrifty White Pharmacy and such purchases will be subject to the Pharmacy’s own terms and conditions it maintains in its normal course of doing business as a licensed pharmacy, including any additional charges for which the patient is responsible. Purchases made through the Direct Purchase Option cannot be combined with any other Novartis offer or program, such as coupons, free trials, prescription savings cards or any other offer not associated with the Direct Purchase Option. Medicines purchased through the Direct Purchase Option will be dispensed within the United States only, including its territories. Patients that are beneficiaries of any federal health care program agree that they shall not seek any reimbursement from their federal health care program or attempt to count any purchase made through the Direct Purchase Option towards any deductible or out-of-pocket costs. Price and corresponding savings percentage subject to change at any time. The Direct Purchase Offer may be changed, modified, or rescinded by Novartis without notice.

By clicking submit, you confirm that you are choosing self-pay which does not involve your insurance. By proceeding, you acknowledge that you will not be able to submit a claim to your insurance provider. If you have questions about obtaining COSENTYX (secukinumab) through insurance, please call Novartis Patient Support at 1-844-COSENTYX (1-844-267-3689). The customer service hours are Monday-Friday, 8:00 AM-8:00 PM ET, excluding holidays.