Siliq

Indicated For

moderate to severe plaque psoriasis

About This Medication

# Bausch Health Patient Assistance Program: How to Get Siliq at Low or No Cost ## About This Program The Bausch Health Patient Assistance Program (BHC PAP) is designed to help uninsured and underinsured patients access Siliq (brodalumab) at no cost for up to 12 months. This program recognizes that prescription costs can be a barrier to treatment and provides eligible patients with direct access to their prescribed medication. ## Who Qualifies for This Program? You may be eligible for the Bausch Health Patient Assistance Program if you meet all of the following criteria: - You are a legal United States resident - You have a valid prescription from a licensed U.S. healthcare professional for Siliq - You are being treated as an outpatient (not hospitalized) - You do not reside in a nursing home, correctional facility, or court-appointed program - Your annual household income does not exceed 300% of the Federal Poverty Level (FPL) based on your household size - You meet specific insurance requirements (see below) ## Income Eligibility Breakdown Your household income must not exceed 300% of the Federal Poverty Level. The Federal Poverty Level guidelines are updated annually by the U.S. Department of Health and Human Services. Here is an approximate breakdown of 300% FPL limits for 2026: | Household Size | Approximate 300% FPL Income Limit | |---|---| | 1 person | ~$42,660 | | 2 people | ~$57,660 | | 3 people | ~$72,660 | | 4 people | ~$87,660 | | 5 people | ~$102,660 | | 6 people | ~$117,660 | | 7 people | ~$132,660 | | 8 people | ~$147,660 | *Note: These are approximate figures. For exact current limits, visit https://aspe.hhs.gov/poverty-guidelines* ## Insurance Requirements You must fall into one of these categories: - **Uninsured**: You have no health insurance coverage - **Denied by commercial insurance**: Your insurance company denied coverage for Siliq and you have exhausted all appeal options - **No government coverage**: You have Medicare Part D, Medicaid, Medigap, VA, DoD, TRICARE, or other federal/state pharmacy assistance, but none of these programs cover Siliq - **Medicare Part D appeal**: If you have Medicare Part D coverage for Siliq, you may appeal for eligibility evaluation on a case-by-case basis Discount cards are not considered prescription drug coverage for eligibility purposes. ## Step-by-Step Application Process **Step 1: Gather Required Documents** Before starting your application, collect the following: - Copy of your medical insurance card (front and back) - Copy of your prescription drug insurance card (front and back) - Proof of income (recent pay stubs, tax returns, or benefit statements) - Your valid prescription for Siliq from your healthcare provider **Step 2: Complete the Patient Application Form** Download the application form from the Bausch Health PAP website. Complete the following sections: - Patient Information (name, address, contact details) - Insurance Information (current coverage details) - Patient Authorization and Certification (sign and date) **Step 3: Have Your Prescriber Complete Their Section** Provide your healthcare provider with the application form. They must: - Complete pages 4, 5, and 6 of the application - Sign the Prescriber Certification - Provide their DEA number and NPI (National Provider Identifier) Your prescriber's signature must be original or electronically signed (e-signature). Stamped signatures are not permitted for controlled substances. **Step 4: Submit Your Application** Submit your completed application and all supporting documents by fax or mail: **Fax:** 844-705-0160 **Mail:** BAUSCH HEALTH PATIENT ASSISTANCE PROGRAM P.O. Box 991624 Louisville, KY 40269 Ensure all required information (marked with an asterisk on the form) is included. Applications with missing information will be placed on hold until complete. ## Timeline and Medication Delivery While specific processing times are not publicly stated, applications are reviewed on a case-by-case basis. Once approved, eligible patients receive Siliq at no cost for up to 12 months from the approval date. Medication is typically shipped directly to your home or to your physician's office, depending on your preference. ## Important Renewal Information - **Annual reauthorization required**: You must reapply annually if you wish to continue receiving assistance - **Medicare Part D patients**: If you are enrolled in Medicare Part D, you must reapply by December 31 each year - **Income and insurance verification**: The program will confirm your continued eligibility annually. Changes in your income or insurance status may affect your eligibility ## What If Your Application Is Denied? If your application is denied, you have several options: 1. **Appeal**: If you believe you meet the eligibility criteria, contact the program to discuss your situation 2. **Reapply**: If your circumstances change (income decreases, insurance coverage ends), you may reapply 3. **Explore alternatives**: Ask your healthcare provider about other patient assistance programs, nonprofit organizations, or state pharmaceutical assistance programs that may help 4. **Contact your prescriber**: Your doctor may have information about other resources or lower-cost alternatives ## Important Disclaimers - Bausch Health Companies Inc. determines participation in the program at its sole discretion - Your prescriber must not be on the List of Excluded Individuals and Entities maintained by the Office of Inspector General - This program is subject to change at any time - Eligibility is based on meeting all stated requirements; meeting some requirements does not guarantee approval - This guide provides general information and should not be considered medical or legal advice ## Questions? For more information about the Bausch Health Patient Assistance Program, visit BauschHealthPAP.com or contact the program directly at 833-862-8727 (8 AM to 5 PM ET).

Program information last verified: March 30, 2026