Need Enrollment Forms for Siliq? Getting Your Patient Started

Shannon E. Epling MSc, Pharmaceutical Sciences Date: 07/06/2023

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Siliq Enrollment Form  

Siliq (brodalumab) is a prescription medication used to treat moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy. It is a human monoclonal antibody that targets the interleukin-17 (IL-17) receptor and works by blocking the action of IL-17A, a cytokine that plays a key role in the development of psoriasis.

However, obtaining access to enrollment forms can be time-consuming and confusing. In this article, we will provide you with access to Siliq enrollment forms and introduce you to Siliq support programs – which provide a variety of HCP and patient resources to streamline the process of prescribing.

Download Siliq Enrollment Forms

Get Siliq REMS enrollment forms to get your patients started on treatment.

Accessing Siliq Enrollment Forms 

To obtain Siliq enrollment forms, you can download the PDF available here. Providers can also visit the Siliq Website or contact a Siliq representative directly at  (855-797-4547).  

Once you have obtained and accurately completed the Siliq enrollment forms with your patient’s information, they can be submitted to the appropriate parties: faxed to (877-204-3888). Siliq enrollment forms require information about your patient’s medical history, insurance coverage, and the reason for prescribing Siliq. Following submission, the process of securing approval for Siliq can take several days to a few weeks.

Siliq Patient Support Programs 

There are several patient support programs offered with Siliq to help patients who are prescribed the medication:

  • SILIQ REMS Program: Siliq is only available through a restricted distribution program called the SILIQ REMS (Risk Evaluation and Mitigation Strategy) program. This program is designed to ensure that the benefits of Siliq outweigh the risks, particularly the risk of suicidal ideation and behavior. The SILIQ REMS program requires healthcare providers to enroll in the program, complete training, and certify that they understand the risks and responsibilities associated with prescribing Siliq.
  • Patient Assistance Program: Valeant Pharmaceuticals, the manufacturer of Siliq, offers a patient assistance program called the Valeant Patient Assistance Program. This program provides financial assistance to eligible patients who cannot afford their medication. Patients who meet certain income and insurance criteria may be eligible to receive Siliq at no cost or at a reduced cost.
  • Nurse Support: Siliq also offers a nurse support program called SILIQ Connect. This program provides patients with access to a registered nurse who can answer questions about Siliq, provide injection training, and offer support throughout the treatment journey.
  • Patient Education: Siliq provides patient education materials, including a patient brochure and website, to help patients understand the risks and benefits of Siliq, how to properly administer the medication, and what to expect during treatment.

Overall, these patient support programs aim to provide comprehensive support for patients who are prescribed Siliq, ensuring they have access to the medication, receive proper training and support, and have resources available to help them manage their condition.


As a healthcare provider, it can be challenging and time-consuming to navigate access to Siliq enrollment forms. With the aid of Siliq support programs and PrescriberPoint, you can gain access to resources and support to help streamline the process of prescribing to ensure that your patients receive the medications they need, when they need them. By utilizing the resources available through the program, you can confirm that your patients receive the best possible care for their autoimmune disorders.


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