To: Kaw, Kristine
From: 
Sent: Thur 1/11/2018 11:10:06 PM
Subject: Re: [EXTERNAL] Injectable medication

Hi Kristine. Thank you for this! I actually sent jeffrey a note about this earlier but still ha e not heard back from him. He is been in constant meetings himself. I will ask him again however and use your much more well versed parag row morning early! Hope to have an answer soon. Thanks and have a great evening

Sent from my iPhone

On Jan 11, 2018, at 6:03 PM, Kaw, Kristine wrote:

Sorry for the late response. Just finished with patients.

-Looking a labs sent from early this month, Lipids done was calculated as opposed to direct LDL. Insurance companies look for the direct LDL when approving medications because this is a more accurate count, therefore, representing a more accurate cardiovascular risk equivalent. When the triglycerides is high, such as in the case of Mr.

Epstein, the lab cannot provide an accurate LDL count. As you can see there was no LDL value given

-If you want to proceed with insurance approval, he will need to re-take labs with direct 101. He cannot start Repatha prior to rechecking labs because it will not be an accurate reflection of his baseline without medications.

-If he wants to self pay, Century Specialty Pharmacy (800-521-3949) is willing to give him a 10% discount if he purchases minimum of 6 months. They will ship the medication over as soon as it's ordered and have it virtually the next day.

-Here is the breakdown of cost:

For the once a month injection $1,250/month (with 10% discount if he buys minimum

## of 6 months)

For the twice a month injection $1,150/month (with 10% discount if he buys minimum of 6 months)

Hope that answers all your questions. I will be available tomorrow if you have any questions. Please let me know what his decision is prescription to the pharmacy is pending his ok. Thanks

KK

## From:

Sent: Thursday, January 11, 2018 12:34 PM To: Kaw, Kristine Subject: Re: [EXTERNAL] Injectable medication

Hello Kristine! I wanted to let you know I DID get Jeffrey's approval confirmed with Repatha and have been able to speak with a nurse on Jeffrey's behalf! A registered nurse is to call me within 1-2 business days to set up his training...truly hoping for next We, Th or Fri! I will be sure to let you know.

## From: (cont.)

Some more questions:

-I understood from Dr. Shimony you will be contacting Jeffrey's insurance to find out about coverage and getting the $5 co-pay card?

-Once insurance approves the medication, when will Jeffrey receive his meds? Hoping he can get 3 months of the medication at a time....let me know if his insurance approves this or how many months we can receive at a time...maybe it is more!?

-will you order Jeffrey a Sharps Container? The nurse was asking me with type of injection he will be getting and I do not know...she said there are 3 different ones...

I know you are busy and will get back to me when you can!! Thank you!

## <u>On Jan 10, 2018,</u> at 4:08 <u>PM, Kaw,</u> Kristine

wrote:

I am so sorry if I can't respond right away since I am seeing patients with Dr. Shimony. I am on the phone now with Repatha. It must have been a misunderstanding, they need the patient, Mr. Epstein, to give permission for you to set up his appointment. Repatha needs to be called again and choose reimbursement services for Mr. Epstein to give you permission moving forward with his training. I will also be faxing you a form to fill out and for Mr. Epstein to sign. This gives Repatha permission to assist him. Are you free to talk to avoid misunderstandings? Thanks KK

## From:

Sent: Wednesday, January 10, 2018 2:43 PM

To: Kaw, Kristine

Subject: Re: [EXTERNAL] Injectable medication

Hi Kristine.

-I found Erica Peltz so no worries there! :)

-I called REPATHA to organize training, but they do not have him registered (which I did) and they tell me you must call them to give me permission to schedule the appointment?! Sounds like silliness to me, but what can I do!? Shc let me register Jeffrey so when you call give them his Acct #PP02BW57 and tell them Lesley Groff, Jeffrey Epstein's personal assistant, may coordinate the training session for him. Once you do this let me know and I will call them back. Would greatly appreciate it.

mi Thanks

## From: (cont.)

On Jan 9, 2018, at 5:37 PM, Kaw, Kristine <blackened out> wrote:

Great thank you. Dr. Shimony states he had recent labs just don't know what his definition of "recent" is. Should be within the past 30 days. Please let me know if any issues and contact by email or office number. KK

## From:

Sent: Tuesday, January 09, 2018 5:27 PM

To: Kaw, Kristine

Subject: [EXTERNAL] Re: Injectable medication

Hi Kristine. Thank you so much for this. Let me find out from Jeffrey if he has lab work that includes cholesterol within past 30 days. I don't think he does but he has gone without me knowing before A. I'll call the <u>number</u> below to set up training. Have a good evening.

## Sent from my iPhone

On Jan 9, 2018, at 5:10 PM, Kaw, Kristine wrote:

Hi Before we get started with the process, I need a copy of Mr. Epstein's recent labs including cholesterol with in the past 30 days. Please let me know if he does not have one so I can send an rx to get it done. We will try to get approval for his medication to avoid paying out of pocket and the company is willing to provide samples while working on his approval.

Please call 1-844-REPATHA to set up a training session and also $5 copay card if medication approved.

Please let me know if you have any questions.

Thank you

Kristine