2 ways to save on SILIQ

We want to bring clear, healthy skin to as many patients as possible.

Instant Savings Program

If eligible, your commercially insured patients may pay as little as $5 per month with commercial insurance coverage for SILIQ.*†

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Enroll Your Patients

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Uninsured patients are not eligible to participate in the Instant Savings Program. These offers are not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B and D Plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs. Siliq Solutions Instant Savings cost support is determined by medication cost only. Amounts are not determined by costs associated with administration of the injection.

*Subject to a $20,000 maximum benefit for 12 months from first eligible date of program participation.

†If their commercial insurance does not cover SILIQ, or coverage is delayed or denied, they may pay as little as $100 per month for SILIQ until coverage is approved or up to 12 months from program initiation.

Eligibility Criteria, Terms, and Conditions for the Siliq Solutions™ Instant Savings Program:
  • These offers are valid for commercially insured patients being treated with SILIQ (brodalumab) injection, for subcutaneous use, for an approved indication, and are good for use only with a SILIQ prescription at the time the prescription is filled.
  • If a commercially insured patient’s insurance covers SILIQ, he or she may pay as little as $5 per month for SILIQ, up to a maximum savings limit of $20,000 for 12 months from the patient's first eligible date of program participation. Patient is responsible for all additional costs and expenses after savings program limit is reached.
  • Participation in SILIQ's $100 per month program, for patients whose commercial insurance does not cover SILIQ, will expire 12 months from program initiation. During this time, health care providers and patients are encouraged to work together to submit appeals to the patient’s health plan in order to obtain coverage to ensure continued treatment with SILIQ.
  • Uninsured patients are not eligible to participate in the instant savings program.
  • These offers are not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state or other governmental programs, including, but not limited to Medicare (including Medicare Advantage and Part A, B and D Plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs.
  • Eligible patients may not seek reimbursement for all or any part of the benefit received through these offers and are responsible for making any required reports of use of these offers to any insurer or other third party who pays any part of the prescription filled.
  • These offers are good only in the USA, including Puerto Rico, at pharmacies enrolled in the SILIQ REMS Program. These offers are not valid in states where otherwise prohibited, taxed, or otherwise restricted.
  • Patient must be 18 years of age or older to redeem these offers for him or herself or for a minor.
  • Each card is valid for up to 26 injections, or 13 new prescriptions of SILIQ.
  • This card is only good for use with SILIQ. No other purchase necessary.
  • These offers and the card are not health insurance.
  • This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. Void if reproduced.
  • These offers are not valid with other offers. This card has no cash value. No cash back.
  • Ortho Dermatologics’ affiliated entities reserve the right to rescind, revoke, terminate, or amend these offers at any time, without notice.
  • The patient understands and agrees to comply with the terms and conditions of these offers.
  • Offers expire December 31, 2020.
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Patient Assistance Program

Ortho Dermatologics is committed to ensuring effective options are available to combat the devastating effects of moderate to severe plaque psoriasis. So, if you have a patient with financial needs, Siliq Solutions is here to help.

Simply fill out the Patient Assistance Program Application and have your patient do the same. Then fax it to the number indicated.

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Patient Assistance
Program Application

To be eligible for the SILIQ Patient Assistance Program (PAP), your patients must meet all program eligibility requirements
  • Patients must have a gross annual income below 400% of the Federal Poverty Level (FPL).
  • The patient must be a legal resident of the United States or Puerto Rico.
  • The patient must have a valid prescription for SILIQ from a duly licensed physician registered with the SILIQ REMS Program.
  • The patient cannot have commercial insurance.
  • The patient’s prescription for SILIQ cannot be eligible for reimbursement, in whole or in part, by any federal, state or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B and D Plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs. However, if the patient has prescription drug coverage under Medicare Part D, an appeal may be filed, which will be assessed on a case-by-case basis.
  • The patient and his or her physician must complete all fields on the PAP application and sign the designated areas on the application.
  • The patient must provide a copy of his or her prescription and proof of income with the application.
  • Applications deemed approved will be valid for a rolling 12 month period (365 days), provided that the patient continues to meet all eligibility requirements throughout the year.

If you have any questions, please call the number below

Call 855-RX-SILIQ

855-797-4547

Monday – Friday,
8am – 5pm ET

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Get SILIQ certified

It’s simple. Enrolling in our REMS program takes just a few minutes.

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Important Safety Information for SILIQ (brodalumab) Injection

INDICATION

SILIQ® injection is indicated for the treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy and have failed to respond or have lost response to other systemic therapies.

IMPORTANT SAFETY INFORMATION

WARNING: SUICIDAL IDEATION AND BEHAVIOR
Suicidal ideation and behavior, including completed suicides, have occurred in patients treated with SILIQ. Prior to prescribing SILIQ, weigh the potential risks and benefits in patients with a history of depression and/or suicidal ideation or behavior. Patients with new or worsening suicidal ideation and behavior should be referred to a mental health professional, as appropriate. Advise patients and caregivers to seek medical attention for manifestations of suicidal ideation or behavior, new onset or worsening depression, anxiety, or other mood changes [see Warnings and Precautions (5.1) in the full Prescribing Information].

Because of the observed suicidal behavior in subjects treated with SILIQ, SILIQ is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the SILIQ REMS Program [see Warnings and Precautions (5.2) in the full Prescribing Information].

Crohn’s Disease

SILIQ is contraindicated in patients with Crohn’s disease. In clinical trials, which excluded Crohn’s patients, one SILIQ patient was withdrawn after developing Crohn’s disease.

SILIQ Risk Evaluation and Mitigation Strategy (REMS) Program

SILIQ is available only through a restricted program called the SILIQ REMS because of observed suicidal ideation and behavior in patients treated with SILIQ. Before prescribing SILIQ, prescribers must be certified with the program, have each patient sign a Patient-Prescriber Agreement Form, and provide the patient a Wallet Card describing symptoms requiring immediate medical evaluation. Pharmacies must be certified and only dispense to patients authorized to receive SILIQ. More information is available at SILIQREMS.com

Infections

SILIQ may increase the risk of infections. Serious infections and fungal infections were observed at a higher rate in patients treated with SILIQ than placebo-treated patients in clinical trials, including one case of cryptococcal meningitis that led to discontinuation of therapy.

  • Consider risks and benefits prior to prescribing SILIQ in patients with a chronic infection or history of recurrent infection
  • Instruct patients to seek treatment if signs or symptoms of a chronic or acute infection occur

Risk for Latent Tuberculosis (TB) Reactivation

Evaluate patients for TB prior to initiating treatment with SILIQ and do not treat patients with active TB. Initiate treatment for latent TB prior to starting SILIQ and consider anti-TB therapy prior to initiation in patients with history of latent TB if adequate treatment cannot be confirmed. Monitor closely for symptoms of active TB during and after treatment.

Immunizations

Avoid use of live vaccines in patients treated with SILIQ.

Adverse Reactions

The most commonly reported adverse reactions in clinical trials were arthralgia, headache, fatigue, diarrhea, oropharyngeal pain, nausea, myalgia, injection site reactions, influenza, neutropenia, and tinea infections.

To report SUSPECTED ADVERSE REACTIONS, contact Customer Service at 1-800-321-4576 or the FDA at 1-800-FDA-1088, or visit www.fda.gov/MedWatch.

Please click here for full Prescribing Information, including Boxed Warning about suicidal ideation and behavior.

Indication
Indication and Important Safety Information

SILIQ® injection is indicated for the treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy and have failed to respond or have lost response to other systemic therapies.

WARNING: SUICIDAL IDEATION AND BEHAVIOR

Suicidal ideation and behavior, including completed suicides, have occurred in patients treated with SILIQ. Prior to prescribing SILIQ, weigh the potential risks and benefits in patients with a history of depression and/or suicidal ideation or behavior. Patients with new or worsening suicidal ideation and behavior should be referred to a mental health

Important Safety Information for SILIQ (brodalumab) Injection

INDICATION

SILIQ® injection is indicated for the treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy and have failed to respond or have lost response to other systemic therapies.

IMPORTANT SAFETY INFORMATION

WARNING: SUICIDAL IDEATION AND BEHAVIOR
Suicidal ideation and behavior, including completed suicides, have occurred in patients treated with SILIQ. Prior to prescribing SILIQ, weigh the potential risks and benefits in patients with a history of depression and/or suicidal ideation or behavior. Patients with new or worsening suicidal ideation and behavior should be referred to a mental health professional, as appropriate. Advise patients and caregivers to seek medical attention for manifestations of suicidal ideation or behavior, new onset or worsening depression, anxiety, or other mood changes [see Warnings and Precautions (5.1) in the full Prescribing Information].

Because of the observed suicidal behavior in subjects treated with SILIQ, SILIQ is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the SILIQ REMS Program [see Warnings and Precautions (5.2) in the full Prescribing Information].

Crohn’s Disease

SILIQ is contraindicated in patients with Crohn’s disease. In clinical trials, which excluded Crohn’s patients, one SILIQ patient was withdrawn after developing Crohn’s disease.

SILIQ Risk Evaluation and Mitigation Strategy (REMS) Program

SILIQ is available only through a restricted program called the SILIQ REMS because of observed suicidal ideation and behavior in patients treated with SILIQ. Before prescribing SILIQ, prescribers must be certified with the program, have each patient sign a Patient-Prescriber Agreement Form, and provide the patient a Wallet Card describing symptoms requiring immediate medical evaluation. Pharmacies must be certified and only dispense to patients authorized to receive SILIQ. More information is available at SILIQREMS.com

Infections

SILIQ may increase the risk of infections. Serious infections and fungal infections were observed at a higher rate in patients treated with SILIQ than placebo-treated patients in clinical trials, including one case of cryptococcal meningitis that led to discontinuation of therapy.

  • Consider risks and benefits prior to prescribing SILIQ in patients with a chronic infection or history of recurrent infection
  • Instruct patients to seek treatment if signs or symptoms of a chronic or acute infection occur

Risk for Latent Tuberculosis (TB) Reactivation

Evaluate patients for TB prior to initiating treatment with SILIQ and do not treat patients with active TB. Initiate treatment for latent TB prior to starting SILIQ and consider anti-TB therapy prior to initiation in patients with history of latent TB if adequate treatment cannot be confirmed. Monitor closely for symptoms of active TB during and after treatment.

Immunizations

Avoid use of live vaccines in patients treated with SILIQ.

Adverse Reactions

The most commonly reported adverse reactions in clinical trials were arthralgia, headache, fatigue, diarrhea, oropharyngeal pain, nausea, myalgia, injection site reactions, influenza, neutropenia, and tinea infections.

To report SUSPECTED ADVERSE REACTIONS, contact Customer Service at 1-800-321-4576 or the FDA at 1-800-FDA-1088, or visit www.fda.gov/MedWatch.

Please click here for full Prescribing Information, including Boxed Warning about suicidal ideation and behavior.