From: Subject: Date: To: Peter Hodge phodge@jaguar.health RE: Media inquiry from Axios April 21, 2020 at 9:24 PM Bob Herman bob@axios.com Dear Bob, Thanks again for reaching out. The following timeline is in response to your questions and takes you on a brief history of our company. We agree with your assessment that the pharmaceutical pricing system is broken and look forward to sharing our issues and approach to continuing to provide the HIV/AIDS community with the only oral plant-based medication to treat chronic and life-altering diarrhea while managing sustainable, fair trade botanical harvesting that supports the indigenous communities that produce our drug Mytesi® (crofemeler). First, it’s important that you know that Mytesi is a first-in-class, non-opioid, plant-based medicine approved by the U.S. Food and Drug Administration to treat noninfectious diarrhea in people with HIV/AIDS who are on antiretroviral therapy, which is an orphan indication. Our team of scientists and ethnobotanists at Napo, Jaguar’s wholly owned subsidiary, started working together more than 30 years ago when they discovered the active ingredient in Mytesi – crofelemer – in the Amazon Rainforest, where it is extracted from the sap of the Croton lechleri tree. Our team achieved what some deemed impossible by driving the development of this plant-based product, which is now the only FDA-approved plant-based oral medication. Since Napo formally launched Mytesi in April 2018, we’ve lost approximately $70 million due to a variety of factors, including maintaining our GMP supply chain from the Amazon Rainforest through India to a finished product in the U.S. These factors are not unique to Napo and pose significant threats to any pharma or biotech that is attempting to remain viable in the current health care system which benefits larger players that can leverage rebates and other financial mechanisms that basically drive smaller companies, which may bring significant innovation to the market, out of business. Because Napo cannot operate at a loss indefinitely, in December 2019 our Board of Directors approved a price adjustment that would coincide with an expansion of the Mytesi patient support program, which includes providing free drug to eligible patients both effective April 1, 2020. The amount of the adjustment was based on market factors, including the significant rising cost of goods and manufacturing in the Amazon, and also the fact that over the last two and half years we have taken a price increase of only 3 percent. Our team worked hard to try find a way to adjust the price while protecting the patients who rely on our product. We are happy to put you in touch with some of the patients who use our product if that is helpful. In accordance with California State Law, Napo provided a 60-day advance notification of the increase on Jan. 31, 2020, before the coronavirus pandemic hit and began reaching out to the physicians and patients who rely on Mytesi to ensure we were doing everything we could to mitigate any negative impact on access to the treatment. During this time, when the coronavirus pandemic hit, a leading U.S. clinician and professor of infectious diseases and epidemiology, who was reviewing research publications from China, noted that 20 percent to 40 percent of COVID-19 patients were experiencing diarrhea when they first presented with the disease. Other research began appearing noting that the virus might have fecal-oral transmission in publications, including the American Journal of Gastroenterology, which published a preprint on March 24, 2020. Our Napo research team, which has been responsible for driving our clinical 24, 2020. Our Napo research team, which has been responsible for driving our clinical trials for Mytesi and its potential use in infectious diarrhea among other GI indications, began pulling together our data and discussing with outside coronavirus experts on whether Mytesi might be able to help. With written endorsement from the aforementioned clinician to the FDA, we submitted our request for Emergency Use Authorization (EUA) for Mytesi for COVID-19 patients to the FDA on March 21, 2020. We held off on implementing the April 1st price change, which we had already communicated on January 31th as noted above, while waiting to hear from the agency since we expected to keep our price at the same level given the temporary emergency situation. On April 7, 2020, we were notified that our application was denied under section 564 and a 10-point criteria provided by the FDA. We do believe that a novel, antisecretory, anti-diarrhea mechanism of action is important for those living with infectious diarrhea. Napo has multiple potential infectious diarrhea indications under development for Mytesi, including published clinical trial results, which is why we applied for the EUA. We implemented the price adjustment, effective April 9, 2020, following the April 7th notification from the FDA. I hope this helps. If you have additional questions, Jaguar’s founder and CEO Lisa Conte is happy to have a discussion with you at 8:00AM ET tomorrow morning, as well. Please reach out to Lisa at lconte@jaguar.health if you would like to speak with her. We would welcome a productive discussion on the challenges we have faced as a small pharma company with a novel product and pipeline and a long-standing commitment to sustainability in a reimbursement environment that is rarely conducive to supporting innovation. All the best, Peter Peter Hodge Senior Director of Investor Relations, Business Development & Special Events Jaguar Health, Inc. 203.539.0423 phodge@jaguar.health www.jaguar.health Follow Us: Facebook Twitter Instagram LinkedIn From: Peter Hodge Sent: Tuesday, April 21, 2020 12:27 PM To: Bob Herman Subject: RE: Media inquiry from Axios Dear Bob, Thanks for reaching out and for the follow-up note. We are aware of your deadline and plan to respond today. All the best, Peter Peter Hodge Senior Director of Investor Relations, Business Development & Special Events Jaguar Health, Inc. phodge@jaguar.health