![]() ![]() These offers and the card are not health insurance.These offers are only good for use with SILIQ.Each offer is valid for up to 26 injections, or 13 new prescriptions of SILIQ.Patient must be 18 years of age or older to redeem these offers for himself or herself or for a minor.These offers are not valid in states where otherwise prohibited, taxed, or otherwise restricted. These offers are good only in the United States, including Puerto Rico, at pharmacies enrolled in the SILIQ REMS Program.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.Notwithstanding the foregoing, 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.Uninsured patients are not eligible to participate in the Instant Savings Program.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. Participation in SILIQ's $50 per month program, for eligible patients whose commercial insurance does not cover SILIQ, will expire 12 months from program initiation.Patient is responsible for all additional costs and expenses after savings program limit is reached. If a commercially insured patient’s insurance covers SILIQ, he or she may pay as little as $0 per month for SILIQ, up to a maximum savings limit of $15,000 for 12 months from the patient's first eligible date of program participation. ![]() The SILIQ Solutions TM Instant Savings Program is valid for eligible, 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 as further described below.Eligibility Criteria, Terms, and Conditions for the SILIQ Solutions™ Instant Savings Program: Amounts are not determined by costs associated with administration of the injection. SILIQ Solutions ™ Instant Savings cost support is determined by medication cost only. 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. Uninsured patients are not eligible to participate in the Instant Savings Program. †If their commercial insurance does not cover SILIQ, or coverage is delayed or denied, they may pay as little as $50 per month for SILIQ until coverage is approved or up to 12 months from program initiation. *Subject to a $15,000 maximum benefit for 12 months from first eligible date of program participation. * Eligible patients without commercial insurance may pay as little as $50 per month. Eligible patients may pay as little as $0 per month with commercial insurance coverage for SILIQ.
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