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Novartis first started treating patients with CTL019 (now Kymriah) in 2012, when the company

entered into a global collaboration with the University of Pennsylvania to further research,
develop and commercialize CAR-T cell therapies, including Kymriah, for the investigational
treatment of cancers.

Because of the sophisticated and individualized nature of Kymriah, Novartis is establishing a


specific network of Canadian treatment centres to offer Kymriah, working with centres that are
FACT-accredited (Foundation for the Accreditation of Cellular Therapy), qualified to perform
allogeneic hematopoietic stem cell transplantation (alloSCT) and have experience with cell
therapies, leukemia and lymphoma.

Novartis is building a fully automatized ordering process integrated with each treatment center.
Novartis is managing training and certification of centres directly, and only these centres will be
able to collect cells for Kymriah manufacturing and subsequently prescribe and administer the
product. Each centre that is part of the network will be fully trained on Novartis’ process related
to the special ordering, cell collection and preparation, and medical training on Health Canada
requirements to ensure optimal and safe administration of Kymriah.

Initially, patients will be able to access the therapy from four treatment centers in Ontario and
Quebec and we are planning to bring additional qualified centres into the network.

The price for Kymriah is currently being finalized. Novartis remains committed to bringing
Kymriah to patients in Canada in a sustainable manner.

As a one-time treatment, the cost of Kymriah is based on value it brings to the health care
system and the society.

More specifically, the cost of treating a patient with Kymriah includes the cost of main therapy
(composed of drug acquisition costs and administration and hospitalization costs), routine
monitoring medical costs, adverse event management costs, subsequent therapy costs
(hematopoietic stem cell transplantation), and indirect costs (productivity gains).

Negotiations with Cancer Care Ontario are ongoing. Novartis is working collaboratively with
multiple government and health system stakeholders to ensure the timely and responsible
adoption of Kymriah in the Canadian healthcare system and are committed to bringing Kymriah
to patients in Canada in a sustainable manner.

Regulatory approval was an important first step to making Kymriah available in Canada.
Bringing this innovative therapy to patients requires collaboration among many health system
stakeholders. We are working closely with stakeholders and a network qualified treatment
centres to prepare for the delivery of Kymriah in Canada and are hopeful that patients in need
will soon be able to benefit from Kymriah .
The Novartis Institutes for BioMedical Research (NIBR) has an extensive research program to
bring new innovations in the field of cell and gene therapy. The NIBR is pursuing personalized
cellular immunotherapy research in collaboration with the University of Pennsylvania with a
number of CAR-Ts in various stages of development including exploratory trials for various
blood cancers and solid tumours.

In 2019, Novartis is planning to open eight trials for new or expanded indications: DLBCL in 2nd
line, adult ALL, high-risk pediatric ALL, FL, pediatric non-hodgkin's lymphoma (NHL), chronic
lymphocytic leukemia (CLL) in combination with ibrutinib, DLBCL in combination with ibrutinib,
and DLBCL in combination with pembrolizumab.

We are committed to starting as quickly as possible and bringing Kymriah to these new
populations. We are also excited about BCMA as a target for multiple myeloma and have a
dedicated team at NIBR working, in collaboration with Penn, on this research.

We are exploring new technologies and combinations of CAR-T such as HuCD19 and BCMA
CAR-T for increasing efficacy, safety and response durability. We are also planning to expand
the platform to new targets: CD22 for ALL, and eGFR for genetic mutations. Furthermore, we
are exploring next-generation manufacturing technology, including combinations and platforms
such as CRISPR.