XTRAC PATIENT ASSISTANCE PROGRAM (PAP) TERMS AND CONDITIONS

By participating in the XTRAC Patient Assistance Program (PAP), you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

• The XTRAC PAP is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare or other federal or state healthcare programs (including any state prescription drug assistance programs). It is also void in any jurisdiction in which rebate programs are subject to tax.

• The XTRAC PAP is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs which reimburse you for the entire cost of your treatments.

• If required by your insurance provider, you must deduct the savings received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.

• The rebate is limited to the lower of your actual out of pocket expense not to exceed the rebate amount or $50.00 per treatment, only 1 rebate allowed per single treatment of XTRAC, 10 rebates per person per course of treatment or $500.00.

• Only a physician or similarly licensed healthcare provider can determine the course of treatments and the treatment protocol. For best results Strata, recommends that patients commit to a protocol that includes twice-weekly treatments.

• In order to qualify for this program, patients must provide proof of receiving a minimum of 8 treatments within 42 days.

• Out of pocket expenses are defined as copays and/or deductible payments that the patient is responsible for as part of the patient’s health insurance program. For patients not covered by insurance and paying personally, out of pocket expenses includes the amount paid by the patient per XTRAC treatment up to $50 for each visit.

• This program is offered to patients beginning a new XTRAC treatment regimen, specifically persons are eligible to submit coupons for additional courses of treatment 90 days from the last treatment date covered by an approved coupon redemption. The coupon is not valid when the entire cost of your treatment is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs.

• The XTRAC PAP is not valid where prohibited by state or local law.

• The XTRAC PAP cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.

• The XTRAC PAP is not health insurance and is not intended to substitute for insurance.

• In order to obtain the rebate you must follow all of the steps and submit all of the documentation called for in the rebate request form. This rebate request form must be submitted within 180 days of the date of the EOB. An original rebate request form signed by the physician and the patient must be submitted for the course of treatments.

• This offer is good only in the fifty United States.

• Certain information pertaining to your participation in the XTRAC PAP will be shared with Strata’s third-party administrator for the program. The information disclosed will include your name and other identifying information, your treatment and treatment dates and any other information on the Explanation of Benefit forms that must be submitted to obtain reimbursement. You expressly consent to the sharing of that information by participating in the program. Additionally, we will retain your information for our records and may use that information to keep you informed of how XTRAC can help.

• The XTRAC PAP is limited to 1 per person’s course of treatment every 90 days and is not transferable.

• In the event of any conflict between the terms herein and those stated in any other documents, including marketing materials, the terms herein shall govern.

• Strata reserves the right to rescind, revoke, or amend the program without notice.

• By agreeing to these terms you also agree to the terms of the www.XTRACCLEAR.com Internet Privacy Policy.

You must acknowledge that you have read and agreed to these terms and conditions in order to proceed with filing or processing your claim for a rebate.