Xeljanz® Medicare Coverage

Xeljanz®
Chemical name: Tofacitinib

Typical dosage: 5mg

Typical type: Tablet1

Xeljanz® is a medication typically used to treat rheumatoid arthritis, psoriatic arthritis and ulcerative colitis. It is currently only available as brand name and is available as an oral tablet in immediate release and extended release dosage forms.

Xeljanz is a prescription medication that contains the active ingredient Tofacitinib. It is taken once or twice daily for the chronic treatment of rheumatoid arthritis, psoriatic arthritis and ulcerative colitis.

Xeljanz is an immunosuppressant that inhibits Janus kinase enzymes to reduce inflammation, joint damage and other symptoms.

The major side effects of Xeljanz include headache, diarrhea, common cold symptoms, runny nose, sore throat and stuffy nose.

Does Medicare cover Xeljanz?

Yes! 69% of Medicare Advantage plans and Medicare Part D plans cover Xeljanz.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Xeljanz.

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Average costs for Xeljanz with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$1,079 – $5,153 $1,079 – $5,153

Additional information

Xeljanz is occasionally used in combination with nonbiologic disease-modifying-antirheumatic drugs (DMARDs) for the treatment of rheumatic and psoriatic arthritis.

While many patients can safely use Xeljanz, it is not currently recommended for women who are pregnant or breastfeeding.

Some patients taking Xeljanz experience serious infections including tuberculosis, shingles, fungal infections and bacterial or viral infections. This risk of infection is increased in patients who take medications that also suppress the immune system, such as methotrexate or corticosteroids.

If you experience any symptoms of infection (fever, chills, sweating, cough, muscle aches, etc.) call your doctor immediately.

You may be evaluated for tuberculosis risk factors or infection before starting Xeljanz, and the presence of tuberculosis may be monitored throughout treatment. Patients with diabetes and/or lung disease should use caution when using Xeljanz because of a higher risk of infection.

Xeljanz may increase your risk of certain cancers – including lymphoma and other skin cancers – by causing changes in your immune system. Renal transplant patients taking Xeljanz have shown an increased rate of Epstein-Barr Virus-associated post-transplant lymphoproliferative disorder.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Xeljanz. Retrieved May 2019, from www.goodrx.com/xeljanz.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.