XELJANZ

Indicated For

Rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, plaque psoriasis, juvenile idiopathic arthritis

About This Medication

# Pfizer Patient Assistance Program Patient Guide: How to Get XELJANZ (tofacitinib) at Low or No Cost XELJANZ (tofacitinib) is a prescription medication used to treat certain inflammatory conditions like rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, and ankylosing spondylitis in adults. The **Pfizer Patient Assistance Program** provides XELJANZ at no cost to eligible uninsured or underinsured patients who meet specific criteria, helping those who struggle with medication costs.[2][6] ## About XELJANZ XELJANZ is a Janus kinase (JAK) inhibitor that works by blocking enzymes involved in inflammation, reducing symptoms like joint pain, swelling, and bowel issues. It comes as an immediate-release tablet (XELJANZ) taken twice daily or extended-release (XELJANZ XR) once daily. Always take it exactly as prescribed by your doctor, and discuss any side effects like infections, blood clots, or cholesterol changes with your healthcare provider. This program focuses on free medication access, not medical advice—consult your doctor for treatment details.[1][2] ## Who Qualifies? The program is designed for patients facing financial hardship who lack adequate insurance coverage. Key eligibility factors include: - **Residency**: You must live in the United States, Puerto Rico, or U.S. Virgin Islands. - **Treatment Setting**: Must be prescribed for outpatient use by a U.S.-licensed healthcare provider. - **Insurance Status**: Primarily for uninsured or underinsured patients, including those with government insurance like Medicare or Medicaid (after exploring other aid). **Commercially insured patients** are not eligible and should use the XELJANZ Co-Pay Savings Program instead.[2][6] - **Income**: Specific thresholds are not publicly detailed in available sources, but the program targets low-income individuals. You may need to apply for other assistance (e.g., Medicaid, Medicare Extra Help) first.[2][6] ## Income Eligibility Breakdown Detailed income limits are not specified in program materials, which is common for manufacturer assistance programs as they assess cases individually. Generally, eligibility aligns with federal poverty levels (FPL), often up to 400-500% FPL, but confirmation requires application. Here's a general reference table based on 2026 U.S. Federal Poverty Guidelines (for context; actual program criteria may vary): | Household Size | 100% FPL | 300% FPL | 400% FPL | |----------------|----------|----------|----------| | 1 (Individual) | $15,060 | $45,180 | $60,240 | | 2 (Couple) | $20,440 | $61,320 | $81,760 | | 3 | $25,820 | $77,460 | $103,280| | 4 | $31,200 | $93,600 | $124,800| *Add ~$5,380 per additional person for larger families. Contact the program for your exact eligibility, as income proof like tax returns or pay stubs is required.*[6] ## Insurance Requirements - **Uninsured**: Directly eligible if income-qualified; first check Medicaid eligibility.[2] - **Underinsured/Government Insurance**: Explore Medicare Extra Help or Medicaid first. If denied, apply here.[2][6] - **Commercial Insurance**: Not eligible; use XELSOURCE Co-Pay Savings (up to $16,000/year savings) or call 1-844-935-5269.[2] XELSOURCE coordinators can help investigate benefits, prior authorizations, and appeals.[1][2] ## Step-by-Step Application Process 1. **Consult Your Doctor**: Confirm XELJANZ is right for you and get a prescription. Your doctor completes parts of the enrollment.[8] 2. **Contact XELSOURCE First**: Call **1-844-935-5269** (Mon-Fri, 8am-9pm ET) to check eligibility, get insurance help, or start PAP referral. They assess if you qualify for Pfizer PAP.[1][2] 3. **Apply via Pfizer RxPathways**: Visit www.PfizerRxPathways.com, search for XELJANZ, and follow instructions. Use online Pfizer PAP Connect if available, or request manual forms.[3][6][7] 4. **Gather Documents**: Provide proof of income (W-2, pay stub, tax return), prescription, and insurance details (attach cards if applicable). Doctor signs enrollment form.[6][8] 5. **Submit**: Phone application preferred at (844) 935-5269; fax forms to 1-866-297-3471 or mail as instructed.[1][8] 6. **Wait for Notification**: Expect updates in 2-3 weeks.[3][6] ## Timeline and Delivery Processing takes **2-3 weeks** after submission. If approved, medication is **shipped directly to your home** via specialty pharmacy (e.g., Sonexus Health). Track status on xelsourcepatientportal.com. Refills require re-enrollment or doctor follow-up; details provided upon approval.[1][2][3] ## Alternatives if Denied - **Appeal**: Request via XELSOURCE for prior auth denials.[1] - **Other Programs**: Medicaid, Medicare Extra Help, or state assistance.[2] - **Co-Pay Card**: For commercial insurance.[2] - **Patient Access Coordinator**: Fax opt-in form for personalized help.[1][5] - **RxPathways Counselor**: Call 1-844-989-PATH (7284).[6] ## Disclaimer This guide is for informational purposes based on publicly available data as of 2026. Eligibility, terms, and availability can change; always verify with Pfizer at 1-844-935-5269 or PfizerRxPathways.com. Not medical advice—speak to your doctor. Pfizer reserves rights to modify or end the program. Word count: 942.

Program information last verified: March 30, 2026