Medicare Part D can cover Siliq (brodalumab), but approval is rarely straightforward. Because Siliq is a self-injected biologic for moderate-to-severe plaque psoriasis, it falls under Part D rather than Part B, and most plans place it behind step therapy requirements, prior authorization, and a federally mandated risk program that limits which pharmacies can even dispense it. If your plan does approve coverage, your annual out-of-pocket spending on Part D drugs is capped at $2,000 in 2025 and $2,100 in 2026, and the Low-Income Subsidy can cut those costs further.
Why Siliq Falls Under Part D
Siliq is a subcutaneous injection patients give themselves at home, which puts it in Part D territory. Part B generally pays for drugs a provider administers in a clinical setting, while Part D pays for medications you take on your own. All biologics approved for plaque psoriasis can be administered by a healthcare provider if a patient prefers, which could shift coverage to Part B in some circumstances, though additional authorization may be required for drugs labeled for self-injection.1JCAD Online. Healthcare Provider Administration Plaque Psoriasis
How Part D Formularies Treat Siliq
Whether your specific plan covers Siliq depends on its formulary, and Siliq is almost never a preferred agent. A Florida Blue Medicare guideline, for example, lists adalimumab products, secukinumab (Cosentyx), etanercept (Enbrel), ustekinumab products, and risankizumab (Skyrizi) as preferred. Siliq is not on that list.2BCBS Florida. Medical Coverage Guideline for Psoriasis UnitedHealthcare goes further, stating that “Siliq is excluded from coverage for the majority of our benefits,” while leaving a narrow authorization path.3UnitedHealthcare. Prior Authorization Notification for Siliq
Step Therapy and Prior Authorization
Even when a plan does not outright exclude Siliq, reaching approval means clearing significant hurdles. Insurers require prior authorization and step therapy, meaning you must document that other preferred treatments failed, caused intolerable side effects, or were medically inappropriate. The specifics vary by insurer:
- UnitedHealthcare requires documented failure, contraindication, or intolerance to three preferred products drawn from a list that includes adalimumab products, Cimzia, Cosentyx, Enbrel, Skyrizi, Sotyktu, ustekinumab products, and Tremfya.4UnitedHealthcare. Step Therapy Program for Siliq
- CVS Caremark may authorize Siliq if you have previously received any biologic or targeted synthetic drug for psoriasis, or if critical body areas (hands, feet, face, scalp, genitals) are affected, or if at least 10 percent of body surface area is involved. For patients with at least 3 percent involvement, inadequate response to phototherapy or conventional drugs like methotrexate must be documented.5CVS Caremark. Specialty Guideline Management for Siliq
- Cigna requires a trial of at least one traditional systemic agent (methotrexate, cyclosporine, acitretin, or phototherapy) for at least three months, plus use of preferred biologic products, before Siliq is considered.6Cigna. Coverage Position Criteria for Inflammatory Conditions – Siliq
- MHN requires documented failure of a preferred adalimumab product, Taltz (ixekizumab), and a ustekinumab product, each tried for at least three consecutive months, plus a prior trial of methotrexate unless the patient has already failed a biologic.7OpenPayer. MHN Brodalumab (Siliq) Coverage Update
Across these policies, Siliq cannot be used at the same time as another biologic or targeted synthetic drug. Plans require the prescriber to be a dermatologist or to have consulted one, and several require documentation that the patient has been evaluated for depression and suicidal ideation risk.
The REMS Program Adds Another Layer
Siliq’s access barriers go beyond insurance. Because four completed suicides occurred among more than 4,400 patients during clinical trials, the FDA approved brodalumab in February 2017 with a boxed warning about suicidal ideation and behavior, and the drug is available only through the SILIQ Risk Evaluation and Mitigation Strategy (REMS) program.8AstraZeneca. Siliq (Brodalumab) Approved by the US FDA9Siliq.com. About SILIQ REMS
Under the REMS, prescribers must be certified with the program, pharmacies must be certified to dispense the drug, and patients must enroll and sign an enrollment form before receiving a first dose. Patients also receive a wallet card listing symptoms that warrant immediate medical attention, such as new or worsening depression, anxiety, or suicidal thoughts.9Siliq.com. About SILIQ REMS You cannot fill a Siliq prescription at a standard retail pharmacy. It flows through specialty channels only.
What You’ll Pay if Your Plan Covers Siliq
Cost-sharing for Medicare beneficiaries has changed significantly under the Inflation Reduction Act. Starting in 2025, Part D out-of-pocket spending is capped at $2,000 per year, rising to $2,100 in 2026.10KFF. Changes to Medicare Part D Under the Inflation Reduction Act11PAN Foundation. Understanding the Medicare Part D Cap The old coverage gap has been eliminated, and a payment-smoothing option lets you spread costs across the calendar year instead of paying steep charges in the first months.
Those caps matter for a drug like Siliq, which was priced at $3,500 per month at launch.12Practical Dermatology. Valeant’s Patient Access and Pricing Committee Announces Pricing for Siliq Before the cap, a beneficiary without Extra Help could have faced 25 to 33 percent coinsurance in the initial coverage phase and further costs in the coverage gap.13PMC. Medicare Coverage of Biologics for Psoriasis Now, total annual exposure is limited to $2,000 (or $2,100 in 2026), as long as the drug is covered by your plan.
If you qualify for Extra Help, also called the Low-Income Subsidy, you pay significantly less. In 2026, Extra Help copays are capped at $5.10 per generic and $12.65 per brand-name prescription, and once total costs reach $2,100, covered drugs cost nothing for the rest of the year.14Medicare.gov. Get Help With Drug Costs Research has shown Medicare beneficiaries with Low-Income Subsidies are substantially more likely to receive biologic therapy than those without, because the financial barrier is so much lower.13PMC. Medicare Coverage of Biologics for Psoriasis
If Your Plan Denies Coverage
You have two main types of exception requests. A formulary exception asks the plan to cover a drug that is not on its formulary or to waive a restriction such as step therapy. A tiering exception asks the plan to charge the copay of a lower cost tier for a drug placed on a specialty tier. The National Psoriasis Foundation recommends tiering exceptions as a strategy for managing biologic costs under Medicare.15National Psoriasis Foundation. Medicare Resources Either request needs a supporting letter from your prescriber explaining why Siliq is medically necessary. Plans must respond within 72 hours for a standard request, or 24 hours for an expedited one.16Medicare Interactive. Introduction to Part D Appeals
If the exception is denied, the formal appeals process has five levels:
- Level 1, plan reconsideration: file within 60 days of the denial notice; the plan decides within 7 days, or 72 hours if expedited.16Medicare Interactive. Introduction to Part D Appeals
- Level 2, Independent Review Entity: file within 60 days of the plan’s denial; decision within 7 days or 72 hours.16Medicare Interactive. Introduction to Part D Appeals
- Level 3, Office of Medicare Hearings and Appeals: requires at least $200 in dispute in 2026; decision within 90 days.16Medicare Interactive. Introduction to Part D Appeals
- Levels 4 and 5: further review by the Medicare Appeals Council and then federal district court, with progressively higher dollar thresholds.16Medicare Interactive. Introduction to Part D Appeals
If an appeal succeeds at any level, the plan must cover the drug through the end of the calendar year. Your State Health Insurance Assistance Program (SHIP) provides free counseling on the process.17SHIP. Part D Appeals
Financial Help Outside the Plan
One boundary to know up front: the manufacturer’s SILIQ Solutions copay support is explicitly unavailable to anyone covered by Medicare, Medicaid, TRICARE, or any other federal or state government health program. Its Instant Savings card, which can bring commercial copays as low as $0 per month, is restricted to private insurance.18Siliq.com. Savings and Support
Two paths remain open. The Bausch Health Patient Assistance Program provides Siliq at no cost to patients who are uninsured or underinsured, generally requiring U.S. residency, an FDA-approved diagnosis, and income at or below 300 percent of the federal poverty level.19Drugs.com. Siliq Price Guide Approved patients receive medication shipped home with no copays or shipping fees, with the benefit lasting up to one year and renewable annually. Applications can be completed by phone or mail and may be approved within 24 to 48 hours.20Bausch Health. Bausch Health Patient Assistance Program
Charitable foundations are another option. The PAN Foundation provides copay grants to Medicare patients and covers 100 percent of out-of-pocket costs for most patients in each disease fund it operates.21PAN Foundation. Changes to PAN Grants Fund availability varies. As of the most recent check, a dedicated plaque psoriasis fund was not listed among PAN’s active funds, but you can join a wait list or use the foundation’s FundFinder tool to receive alerts when assistance opens.22PAN Foundation. Our Grants
Alternatives Medicare Plans Are More Likely to Cover
Because Siliq sits behind steep step therapy and is excluded from some formularies entirely, many Medicare beneficiaries with plaque psoriasis end up on other biologics that plans treat as preferred:23National Psoriasis Foundation. Current Biologics on the Market
- IL-17 inhibitors (Siliq’s own class): Cosentyx (secukinumab), Taltz (ixekizumab), and Bimzelx (bimekizumab).
- IL-23 inhibitors: Skyrizi (risankizumab), Tremfya (guselkumab), and Ilumya (tildrakizumab).
- TNF inhibitors: Humira (adalimumab) and its biosimilars, Enbrel (etanercept), and Remicade (infliximab).
- IL-12/23 inhibitors: Stelara (ustekinumab) and its biosimilars.
Part D formularies have been shifting toward biosimilars under Inflation Reduction Act incentives. About half of prescription drug plan beneficiaries lost access to brand-name Humira during the 2025 plan year while gaining coverage for adalimumab biosimilars, and Stelara biosimilars began launching in 2025.24Milliman. Prescribing Part D Formulary Under the New IRA Trying these preferred agents first is, by design, what most plans require before they will approve Siliq.