Xeljanz XR is the brand name for the oral prescription of the generic drug tofacitinib. Xeljanz XR is a Janus kinase inhibitor (JAK) that works by blocking the activity of certain members of the Janus kinase family of enzymes. Inhibition of these Janus kinase enzymes reduces inflammation, pain, and joint damage in cases where there is severe rheumatoid or psoriatic arthritis.
Doctors commonly prescribe Xeljanz XR to treat adults who are living with severe rheumatoid or psoriatic arthritis and have been previously treated unsuccessfully with methotrexate.
Use of Xeljanz XR may help relieve the pain, tenderness, and joint swelling that accompanies these two forms of auto-immune arthritis. If you are living with the pain and discomfort of either rheumatoid or psoriatic arthritis, your quality of life may be lowered, and you may find even simple activities difficult.
Today there are over 54 million Americans who have some form of arthritis. There are 1.3 million Americans that have rheumatoid arthritis, and 2 percent of the U.S. population has psoriatic arthritis. If you are one of the millions living with either rheumatoid or psoriatic arthritis and methotrexate has not successfully treated your symptoms, your health care provider may suggest that you try Xeljanz XR. The question is, do your Medicare benefits cover the cost of this prescription drug? Let’s find out.
Medicare Benefits for Xeljanz XR
If you do not have a Medicare Part D or Medicare Advantage plan with prescription drug coverage, you may pay substantially more for Xeljanz XR. Prices vary across the United States, but the national average retail cost for 30 tablets of 11 mg. runs between $4,290.00 and $4,700.00.
You may have coverage for Xeljanz XR if you have either a Medicare Part D, or Medicare Advantage plan that includes prescription dug coverage. Medicare Part D, or the Medicare prescription drug benefit, is an optional plan that you can sign up for when you become eligible for Medicare benefits. In the United States there are between 40 and 50 different companies that offer prescription drug plans in each state. You can choose which plan to enroll in based on your individual needs and economic capabilities.
When looking for a Medicare Part D policy, you should consider the company’s formulary. This is a list of the drugs that the plan covers. You can find information online or ask for a printed copy from the insurance agency.
Every company that offers Medicare Part D coverage categorizes the drugs it covers in three tiers. These tiers determine your final cost. Tier one includes generic prescription drugs. These drugs have the lowest copayment. Tier two includes preferred name-brand prescription drugs and carry a medium copayment. Finally, tier three includes drugs that are non-preferred brand-name prescription drugs with the highest copayment.
You may also have coverage for Xeljanz XR if you have a Medicare Advantage (Part C) plan. This depends on what drugs your policy’s formulary includes. Contact your plan directly for more specific information.
Your final cost for a prescription drug like Xeljanz XR depends on your plan’s deductible and whether you are paying a copayment (set amount) or coinsurance (set percentage), what tier the drug is on, and where you purchase the drug.
Getting relief from the pain and discomfort of severe rheumatoid or psoriatic arthritis can raise your quality of life and make everyday tasks much easier to perform. If your health care provider suggests that you try Xeljanz XR, you may have coverage for a large percentage of its cost if your Medicare Part D or Medicare Advantage insurance plan includes this prescription drug on its formulary. You can get more information from your physician or an agent representing your insurance company.
Does Medicare Cover Lyrica?(Opens in a new browser tab)