U.S. State Law Consent to Health Data Use for Patient Support Programs

I consent to Incyte collecting, using and disclosing my health data for the following purposes:

• To enroll me and manage my participation in Incyte’s Voices of MPN program, which includes activities related to my condition or treatment (for example, co-pay card programs, payer medication coverage verification, nurse educator support, disease management support), and to manage Incyte’s products, services, and programs related to my condition or treatment.

Incyte uses the following when it administers the Incyte Voices of MPN 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 this use of my health data is required for me to participate in the Incyte Voices of MPN Program. I also understand that Incyte will not sell my health data to third parties, but Incyte may disclose my health data to Incyte’s vendors only for Incyte’s business purposes related to the Incyte Voices of MPN program I understand that Incyte may use my health data to contact me by email, 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 program. Finally, I understand that I may withdraw my consent to processing my health data for the above purposes at any time by calling 855-446-2983 or visiting www.incyte.com/privacy-policy and that if I withdraw my consent, I will no longer be able to participate in the program. I understand that this consent will remain in effect for one year.

By signing the consent to use, I agree that these entities may use my health information to administer the Program or as permitted or required by applicable privacy laws. I permit such use for one year after the dates I sign the consent, unless and until I revoke it in writing prior to that time.