AimAlly Refill Reminder Form | Aimovig (erenumab-aooe)

Enroll in the AimAlly^™ text message refill reminder program

Have helpful Aimovig® prescription refill reminders sent straight to your phone! Our AimAlly^™ Messaging program will send you a monthly text message on a day of your choosing to remind you of when to pick up your medication.

Please provide the information below to enroll in the Program

*Required Information

*First Name

Please enter a first name

*Last Name

Please enter a last name

You must be 18 years or older to enroll in the AimAlly^™ Messaging program.

*Date of Birth

What day of the month would you like to receive your refill reminder?*

Please select day

When selecting the date, consider when your next refill is due according to when you last picked up your prescription.

Time zone where you live*

Please select Time Zone

*Email Address

Please enter a valid email address

*Confirm Email Address

The Email and Confirm Email fields do not match

*Mobile Phone Number

Please enter a mobile phone number

*Zip Code Enter valid 5 digit numeric zip

Consents

Step 1 of 3

*Please make a selection

Consent to Health Data Processing for AimAlly™ Messaging

I consent to Amgen processing my Health Data for the following purposes:

To enroll me and manage my participation in Amgen’s AimAlly™ Messaging program, which includes activities related to my condition or treatment (for example, co-pay card programs, payer medication coverage verification, nurse partner support, disease management support), and to manage Amgen’s products, services, and programs related to my condition or treatment.

Amgen uses the following when it administers the AimAlly™ Messaging program:

Health Data – my name (and the name of my caregiver if applicable), gender, date of birth, contact information and information relating to my health condition or treatment.

I understand that my consent to processing is required for me to participate in the AimAlly™ Messaging program. I also understand that Amgen will not sell my Health Data to third parties, but Amgen may disclose my Health Data to Amgen’s data processors, contractors, and business partners for Amgen’s business purposes related to the AimAlly™ Messaging program. I understand that Amgen may use my Health Data to contact me by mail, email, telephone, or text for the above purposes. I also understand that if I do not consent to the use of my Health Data for the above purposes, I will not be able to participate in the AimAlly™ Messaging program. Finally, I understand that I may withdraw my consent to processing my Health Data for the above purposes at any time using one of the methods listed in the Additional Disclosures section below and that if I withdraw my consent, I will no longer be able to participate in the AimAlly™ Messaging program.

I consent to the collection, processing, and disclosure of my Health Data for the above purposes I do not consent to the collection, processing, or disclosure of my Health Data for the above purposes By selecting “I do not consent to the collection, processing, or disclosure of my Health Data for the above purposes,” you will not be able to continue enrolling in AimAlly™ Messaging By selecting “I do not consent to the collection, processing, or disclosure of my Health Data for the above purposes,” you will not be able to continue enrolling in AimAlly™ Messaging

Step 2 of 3

*Please make a selection

Consent to Health Data Collection & Processing for Marketing Purposes

I consent to Amgen collecting and processing my Health Data for the following purposes:

To conduct marketing activities, including market research activities, and to communicate with me regarding products and services that may be of interest to me.

Amgen uses the following for marketing purposes:

Health Data – my name, gender, date of birth, contact information and information relating to my health condition or treatment.

I understand that Amgen is seeking my consent to collect and process my Health Data to market products and services to me and that I do not have to give consent to the collection and processing of my Health Data for marketing purposes in order to participate in the AimAlly™ Messaging program. I also understand that Amgen will not sell my Health Data to third parties. If I consent to the collection and processing of my Health Data for marketing purposes, I agree that Amgen may contact me for marketing purposes. Finally, I understand that I may withdraw my consent to the collection and processing of my Health Data for marketing purposes at any time using one of the methods listed in the Additional Disclosures section below.

I consent to the collection and processing of my Health Data for marketing purposes I do not consent to the collection and processing of my Health Data for marketing purposes If you do not consent to the collection and processing of your health data for marketing purposes, you will not be able to receive marketing communications from Amgen. If you want to receive marketing communications from Amgen, select “I consent to the collection and processing of my Health Data for marketing purposes” If you do not consent to the collection and processing of your health data for marketing purposes, you will not be able to receive marketing communications from Amgen. If you want to receive marketing communications from Amgen, select “I consent to the collection and processing of my Health Data for marketing purposes”

Step 3 of 3

*Please make a selection

Consent to Health Data Disclosure for Marketing Purposes

I consent to Amgen disclosing my Health Data to its data processors, contractors, and business partners for the following purposes:

To conduct marketing activities, including market research activities, and to communicate with me regarding products and services that may be of interest to me.

If I provide my consent, Amgen will disclose the following for such purposes:

Health Data – my name, gender, date of birth, contact information and information relating to my health condition or treatment.

I understand that Amgen is seeking my consent to disclose my Health Data to its data processors, contractors, and business partners to market products and services to me and that I do not have to give consent to disclosure of my Health Data for marketing purposes in order to participate in AimAlly™ Messaging. I also understand that Amgen will not sell my Health Data to third parties. Finally, I understand that I may withdraw my consent to the disclosure of my Health Data for marketing purposes at any time using one of the methods listed in the Additional Disclosures section below.

I consent to the disclosure of my Health Data for marketing purposes I do not consent to the disclosure of my Health Data for marketing purposes If you do not consent to the disclosure of your health data for marketing purposes, you will not be able to receive marketing communications from Amgen. If you want to receive marketing communications from Amgen, select “I consent to the disclosure of my Health Data for marketing purposes” If you do not consent to the disclosure of your health data for marketing purposes, you will not be able to receive marketing communications from Amgen. If you want to receive marketing communications from Amgen, select “I consent to the disclosure of my Health Data for marketing purposes”

Additional Disclosures

I understand that participation in the AimAlly™ Messaging program and, if I have consented, receipt of marketing communications are optional services at no cost to me. The consent(s) above in no way affects my right to obtain any medications and I do not have to provide consent to be able to receive any medications. To obtain a copy of the consent(s) above or to withdraw my consent to collection, processing, and/or disclosure of my Health Data for any of the above purposes to which I have consented, I can contact Amgen by visiting www.amgen.com/DataSubjectRights or calling 1-833-246-6844. For more information about Amgen’s privacy practices, Amgen’s Privacy Statement can be found at http://www.amgen.com/privacy.

By clicking Enroll below, you are agreeing to the Terms and Conditions

Contact us here

1-833-AIMOVIG (1-833-246-6844)

8AM–9PM ET, Mon–Fri

Enroll in the AimAlly^™ text message refill reminder program

Consents

Step 1 of 3

*Please make a selection

Step 2 of 3

*Please make a selection

Step 3 of 3

*Please make a selection

Additional Disclosures

Contact us here

Important Safety Information

Important Safety Information

Approved Use

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Tools & Resources

Enroll in the AimAlly™ text message refill reminder program

Consents

Step 1 of 3

*Please make a selection

Step 2 of 3

*Please make a selection

Step 3 of 3

*Please make a selection

Additional Disclosures

Contact us here

Important Safety Information

Important Safety Information

Approved Use

Enroll in the AimAlly^™ text message refill reminder program