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TIER 0 (25mg total) $249 total for 8-10 week supply Monthly cost breakdown: $99 Recommended if using low (or micro) doses of 2mg/week or less TIER 1 (50mg total) $345 total for 10 week supply Monthly cost breakdown: $138 Recommended if new to treatment or for those on 2-5mg/week TIER 2 (75mg total) $399 total for 8-10 week supply Monthly cost breakdown: $159-$199 based on weekly dose Recommended for those on 6-9mg/week TIER 3 (100mg total) $475 total for 8-10 week supply Monthly cost breakdown: $190-$237 based on weekly dose Recommended for those on 10-12mg/week TIER 4 (141mg total) $599 total for 9-10 week supply Monthly cost breakdown: $239-$266 based on weekly dose Recommended for those on 13mg/week and up Empower Pharmacy - Tirzepatide/Niacinamide Injection Up to 70 days BUD

Each lot has a Certificate of Analysis with mass spectrometry confirmation available upon request

Injection volumes were calculated using the most recently recorded animal weight and adjusted weekly

Format: Vial

We believe our finalized policy to give hospitals the option to use an alternative, equivalent source of remittance data that includes the same information as EDI 835 ERA transaction data is responsive to commenters' concerns about the lack of availability of EDI 835 ERA transaction data for certain hospitals and mitigates concerns of burden associated with accessing EDI 835 ERA transaction data for such hospitals