Xeljanz Medicare Coverage

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.

How much does Xeljanz cost with Medicare?

Xeljanz coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Xeljanz?

According to GoodRx, 84% of Medicare Advantage plans and Medicare Part D plans covered Xeljanz in 2023.¹

• Medicare Advantage plans or Part D plans that cover Xeljanz include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2024 Medicare Advantage plans include prescription drug coverage.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. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

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.