Siklos

Indicated For

sickle cell disease

About This Medication

# Medunik USA Patient Assistance Program Guide: How to Get Siklos at Low or No Cost ## About This Program The Medunik USA Patient Assistance Program helps patients with sickle cell anemia access Siklos (hydroxyurea) at reduced or no cost if they meet certain financial and insurance requirements. Siklos is an important medication that helps reduce the frequency of vaso-occlusive crises and other complications of sickle cell disease. ## About Siklos (Hydroxyurea) Siklos is a prescription medication used to treat sickle cell anemia. It belongs to a drug class called antimetabolites and works by helping to reduce the painful complications associated with sickle cell disease. Your doctor has determined that Siklos may be an appropriate treatment for your condition. ## Who Can Qualify? You may be eligible for the Medunik USA Patient Assistance Program if you meet ALL of the following criteria: - You have been prescribed Siklos by your healthcare provider - You are a U.S. resident - Your family has no commercial insurance OR your insurance does not cover Siklos - Your household income falls below the program's threshold for your family size ## Income Eligibility Income limits vary based on your household size. Contact the program directly at **(844) 716-4663** to confirm the exact income threshold for your situation, or visit the program website at https://hcp.siklosusa.com/savings. Income is typically calculated as your gross household income for the past 12 months. This includes income from all sources for all household members. ## Insurance Requirements This program is designed to help uninsured patients or those whose commercial insurance does not cover Siklos. If you have commercial insurance that covers this medication, you should work with your insurance company first. However, if your insurance denies coverage or you are uninsured, you may qualify for this assistance program. ## Step-by-Step Application Instructions ### Step 1: Gather Required Documents Before starting your application, collect the following: - **Completed application form** (pages 1 must be signed by both your physician and you or your legal guardian) - **Proof of income** such as: - Recent tax returns (last 2 years) - Recent pay stubs (last 2-3 months) - Benefit statements (Social Security, disability, unemployment, etc.) - Bank statements or letters from employers - If self-employed: business tax returns or profit/loss statements ### Step 2: Work with Your Doctor's Office Your healthcare provider must complete and sign the application form. Ask your doctor's office staff to help you obtain the application and ensure they sign the required section. They will verify medical necessity and your prescription for Siklos. ### Step 3: Complete Your Section Fill out your portion of the application form completely and accurately. Make sure both you (or your legal guardian) and your physician sign and date the form. ### Step 4: Submit Your Application Submit your completed application and supporting documents by **fax** to: **Fax Number: 800-887-1338** Make sure to include: - Completed application form (signed by both physician and patient/guardian) - Proof of income documents - Any other requested documentation Keep a copy for your records. ### Step 5: Wait for Processing The program typically processes applications within **4-8 weeks**. You may receive updates via mail or phone during this time. ## After You're Approved If you are approved, Siklos will be shipped directly to your physician's office, not to your home. Your doctor's office will contact you when the medication arrives so you can pick it up or arrange for delivery to your home pharmacy. ## If You Have Insurance If you have commercial insurance that covers Siklos, you may also benefit from the **Siklos Savings Card** available at https://hcp.siklosusa.com/savings. This card may help reduce your out-of-pocket costs even with insurance coverage. ## What If Your Application Is Denied? If the program denies your application, ask for a written explanation of why you were not approved. Common reasons include: - Income above program threshold - Having commercial insurance that covers the medication - Incomplete or missing documentation - Not meeting other eligibility criteria If denied, ask if you can reapply with additional information, or explore other options such as: - Reapplying if your financial situation changes - Contacting your insurance company to appeal a coverage denial - Asking your doctor about alternative treatments - Seeking help from state pharmaceutical assistance programs ## Timeline and Delivery - **Application Processing:** Typically 4-8 weeks - **Delivery:** Shipped directly to your physician's office - **Your Next Steps:** Your doctor's office will contact you when medication arrives ## Questions or Need Help? Contact the Medunik USA Patient Assistance Program: - **Phone:** (844) 716-4663 - **Website:** https://hcp.siklosusa.com/savings - **Fax:** 800-887-1338 Program staff can answer questions about eligibility, help you understand what documents are needed, and track your application status. ## Important Legal Notice This guide is for informational purposes only and does not constitute medical or legal advice. The Medunik USA Patient Assistance Program terms, conditions, and eligibility requirements may change at any time. For the most current and complete program information, visit the official program website or contact the program directly. Always work with your healthcare provider regarding your treatment and medication needs. --- *Last Updated: 2024 | Always verify current program details with Medunik USA*

Program information last verified: March 25, 2026