Getting you where you want to go
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 financial needs, Siliq Solutions is here to help. Simply fill out the Patient Assistance Program Application and bring it to your doctor's office.
To be eligible for the SILIQ Patient Assistance Program (PAP) you must meet all program eligibility requirements:
- You must have a gross annual income below 400% of the Federal Poverty Level (FPL).
- You must be a legal resident of the United States or Puerto Rico.
- You must have a valid prescription for SILIQ from a duly licensed physician registered with the SILIQ REMS Program.
- You cannot have commercial insurance.
- Your 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 you have prescription drug coverage under Medicare Part D you may file an appeal, which will be assessed on a case-by-case basis.
- You and your physician must complete all fields on the PAP application and sign the designated areas on the application.
- You must provide a copy of your prescription and proof of your income with your application.
- Applications deemed approved will be valid for a rolling 12-month period (365 days), provided that you continue to meet all eligibility requirements throughout the year.
If you have any questions, please call 855-RX-SILIQ (855-797-4547) for assistance.