ABOUT XELSOURCE SM
When you’re starting out on treatment, support services from XELSOURCE can help by:
Your XELSOURCE specialist can help you with:
- Finding a place to fill your prescription
- Providing a reminder when it’s time to refill your prescription
- Working with you and your pharmacy if your insurance requires reauthorization once you are on treatment
Your XELSOURCE specialist can provide financial support by:
FINANCIAL HELP QUESTIONS
If you have private insurance, you may qualify for a Co-Pay Savings Card and pay out-of-pocket costs as low as $0 per month. If your pharmacy does not accept the Co-Pay Savings Card, or you forgot your card, a rebate form is available. See limits, terms, and conditions. Eligibility is not based on income.
If you have government insurance, such as Medicare Part D or Medicaid, or if you need more financial assistance, we can also evaluate your eligibility for a Hardship Assistance Program. If you are eligible, we will provide XELJANZ or once-daily XELJANZ XR at no cost to you.
If you have no insurance, we will evaluate your eligibility for our Patient Assistance Program. If you are eligible, we will provide XELJANZ or once-daily XELJANZ XR at no cost to you.
To speak with a XELSOURCE specialist about what savings options may be available, call 1-855-4XELJANZ (1-855-493-5526), Monday through Friday, 8:00 AM–8:00 PM ET, and say “Representative.”
If you are eligible, your healthcare provider can request a free, 14-day trial prescription for you. See limits, terms, and conditions.
If you qualify for a Co-Pay Savings Card, it can be used for either XELJANZ or XELJANZ XR.
When switching from XELJANZ to once-daily XELJANZ XR additional approvals may not be required. For more information, check with your insurance provider.
Health plans can change—so can your health insurance and prescription benefits. Once your new plan begins, XELSOURCE can help review your plan information, obtain Prior Authorization (PA) (if needed), and verify your prescription coverage.
If your request is denied, you still may be eligible to receive XELJANZ or once-daily XELJANZ XR at no cost. Call XELSOURCE for help navigating the approval process and to learn more about the support services that may be available to you.
To speak with a XELSOURCE specialist, call 1-855-4XELJANZ (1-855-493-5526), Monday through Friday,