Addyi Patient Provider Agreement Form

Raleigh, N.C – September 21, 2015 – Sprout Pharmaceuticals, Inc. (Sprout) today announced that pharmacists and health pharmacists can now undergo training to obtain prescription or dispensing certification under the Addyi Risk Evaluation and Strategy Mitigation (REMS) program. Addyi, the first FDA-approved treatment for the most common form of sexual dysfunction in women, is a non-hormonal pill once a day to treat the generalized hypoactivity sexual pleasure disorder (HSDD) acquired in pre-menopausal women. It is only available through certified health professionals and pharmacies that are registered in this program. Frequently Asked Questions (FAQ) Treatment Authorization Request (TAR) Antipsychotic Drug Limitation for 0-17 Population Prescriber FAQs Update January 22, 2015 1. What information is needed Certification documents are available online at www.Addyi.com. To complete the certification process, prescribers and pharmacists must send completed knowledge assessment and registration documents to 844-694-3373 or send email-scanned copies to [email protected]. Sprout Pharmaceuticals has prepared a patient-supplier agreement to be signed by both parties. This agreement includes a breakout section for patients in which they explain the risks of alcohol consumption during Addyi treatment and give instructions for softening and handling controls, dizziness and fainting.

For more information: Amy Rose Edelman 312-297-6912 media@sproutpharma.com www.sproutpharma.com/sprout-pharmaceuticals-receives-fda-approval-addyi-flibanserin-100-mg/ HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not contain all the information necessary for the safe and effective use of ADDYI. For more information on prescribing, see ADDYI. AddYI (flibanserin) ADDYI Travelling pharmacies must appoint a representative to provide training and knowledge assessments, train their staff and advise any patient who receives alcohol. Stationary pharmacies have similar training requirements and cannot spend flibanserin for outpatient use. REMS will address these risks by requiring all prescribed individuals to undergo training and knowledge assessment of the risks associated with flibanserin and by enrolling in an REMS certification program for the drug.