Sign Up for Your Co-Pay Savings Card

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By filling out this form, you acknowledge you are over 18 years old.

Only current commercially-insured XELJANZ patients are eligible for the Co-Pay Savings Card. To learn more about XELJANZ XR and if it could be the next step in treating your moderate to severe rheumatoid arthritis (RA), please review the following pages:

  • I am 18 years or older.
  • I do not purchase my prescription medication through a federal or state prescription drug program such as Medicare or Medicaid.
  • I agree with the Terms and Conditions.

Pfizer understands your personal and health information is private. The information you provide will only be used by Pfizer and parties acting on its behalf to send you the materials you requested and other helpful information and updates on XELJANZ, as well as related treatments, products, offers, and services.