Siklos

Indicated For

sickle cell anemia

About This Medication

# Siklos Patient Assistance Guide: Getting Hydroxyurea at Low Cost ## Overview If you have sickle cell anemia and struggle to afford Siklos (hydroxyurea), the Medunik USA Patient Assistance Program can help. This program provides free or reduced-cost medication to eligible patients who cannot afford their prescriptions. ## Who Qualifies? ### Income Requirements You may qualify based on your household income. Income limits vary by family size and are adjusted annually. Most programs accept families earning up to 200-400% of the federal poverty level, though Medunik USA's specific limits can vary. Contact the program directly at **(844) 716-4663** to confirm current income thresholds for your household size. ### Insurance Status You're eligible if you: - Have **no commercial health insurance**, OR - Have commercial insurance that **does not cover Siklos** Medicare and Medicaid patients may have different pathways—check with the program about your specific coverage. ## What You'll Need to Apply Gather these documents before applying: 1. **Proof of Income** - Recent tax returns (last 2 years) - Recent pay stubs (last 30 days) - Unemployment or benefits statements - Proof of disability or SSI benefits - Bank statements (if self-employed) 2. **Completed Application** - Page 1 must be signed by your physician - Page 1 must also be signed by you or your legal guardian - Complete all required patient information 3. **Insurance Documentation** (if applicable) - Current insurance card or denial letter - Proof that your plan doesn't cover Siklos ## How to Apply ### Step 1: Get Your Application Visit **https://hcp.siklosusa.com/savings** or call **(844) 716-4663** to request the application form. ### Step 2: Complete the Application - Fill out all sections with accurate information - Have your doctor complete and sign page 1 - Sign page 1 yourself (or have your legal guardian sign if you're a minor) ### Step 3: Gather Supporting Documents - Collect recent proof of income documents - Include any insurance documentation - Make copies for your records ### Step 4: Submit by Fax Send your completed application and documents via fax to Medunik USA. Use the fax number provided on the application form, or call **(844) 716-4663** for transmission instructions. ## What Happens Next? **Timeline**: Most decisions are made within 1-2 weeks of receiving a complete application. You'll be contacted by phone or mail with the decision. **If Approved**: You'll receive information about: - Your cost (free or reduced-price) - How to obtain your medication - Any additional requirements - Refill instructions **If Denied**: You have the right to appeal. Contact the program to understand the reason and discuss your options. ## Important Program Features ### No Reauthorization Required Once approved, you typically won't need to reapply annually. However, inform the program immediately if your financial situation improves significantly or your insurance coverage changes. ### Savings Card Available The program also offers a savings card for patients with commercial insurance. Even if you don't qualify for free medication, you may reduce your copay significantly. ### Biosimilar Status There are currently no biosimilar alternatives to Siklos available. ## Contact Information **Medunik USA Patient Assistance Program** - Phone: **(844) 716-4663** (toll-free) - Website: https://hcp.siklosusa.com/savings - Fax: Available upon request when you call ## Tips for Success - **Apply early**: Start the process before your medication runs out - **Be complete**: Submit all required documents to avoid delays - **Stay in touch**: Keep the program updated if your information changes - **Ask questions**: Don't hesitate to call with concerns—representatives can help you understand requirements - **Work with your doctor**: Your physician can help expedite approval by promptly signing and returning the application ## Next Steps 1. Call **(844) 716-4663** to confirm you qualify and request an application 2. Gather your income documentation 3. Have your doctor complete the form 4. Fax everything in within a few days 5. Wait for approval notification You don't have to struggle with medication costs. The Medunik USA Patient Assistance Program exists to help you access the Siklos you need.

Program information last verified: March 25, 2026