tofacitinib citrate
1 MG/ML, 10 MG, 5 MG — Solution
ANTIRHEUMATIC - ENZYME INHIBITORS
Also known as:
tofacitinib citrate soln 1mg/ml; tabs 5mg, 10mg; tb24 11mg, 22mg
tofacitinib citrate soln 1mg/ml
tofacitinib citrate tabs 5mg; tb24 11mg
tofacitinib citrate tabs 10mg; tb24 22mg
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Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Bronze Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + Two Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Enhanced + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + Three Free PCP Visits + Free 24/7 Preferred Provider PCP/Urgent Virtual Care + No Referrals
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield Federal
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBS Federal Focus 2026 | Tier 2 - Preferred Brand | ✓ | — | — | PA |
| BCBS Federal Standard Option 2026 | Tier 4 - Preferred Specialty | ✓ | — | — | PA |
| BCBS Federal Basic Option 2026 | Tier 4 - Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Standard Option 2026
via Xeljanz Xr |
Tier 5 - Non-Preferred Specialty | ✓ | — | — | PA |
|
BCBS Federal Basic Option 2026
via Xeljanz Xr |
Tier 5 - Non-Preferred Specialty | ✓ | — | — | PA |
Blue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBSNC Blue Care 2026
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Home with UNC Health Alliance 2026
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Local 2026
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Advantage 2026
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
|
BCBSNC Blue Value 2026
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ Restricted Access | PA | QL |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect Bronze 5500 Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3600 Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3000 Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold RD CMS Standard
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 2200 Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD CMS Standard
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 5000 Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 3500 Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD CMS Standard
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 6000 Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 5000 Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold 1500 Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Silver
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Bronze
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold CMS Standard
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver CMS Standard
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze CMS Standard
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 6500 Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 5000 Indiv Med Deductible
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
Medicare Part D
30 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Xeljanz Xr |
Tier 1 - Preferred Generic | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Xeljanz Xr |
Tier 1 - Preferred Generic | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Xeljanz Xr |
Tier 1 - Preferred Generic | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Signature (HMO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
HealthTeam Advantage Vitality Plan (PPO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
HealthTeam Advantage Plan II (PPO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
HealthTeam Advantage Plan I (PPO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Signature Giveback (PPO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Signature Extra (PPO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Enhanced (PPO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Enhanced (PPO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Signature (PPO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
DEVOTED CORE 001 NC (HMO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Enhanced (HMO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Signature Care (HMO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Prime (HMO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Value Plus (HMO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Signature (HMO)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
Aetna Medicare Dual (HMO D-SNP)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Xeljanz Xr |
Tier 5 - Specialty | ✓ | — | ✓ 30 per 30 days | PA | QL |
NC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 4 - Specialty Generic | ✓ | — | ✓ Preferred for | PA | QL |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 4 - Specialty Generic | ✓ | — | ✓ Preferred for | PA | QL |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 4 - Specialty Generic | ✓ | — | ✓ Preferred for | PA | QL |
TRICARE
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| TRICARE Uniform Formulary 2026 | Tier 1 - Generic Formulary | — | ✓ | — | ST Step therapy: XELJANZ,XELJANZ XR W/O USE OF BRAND XELJANZ, XELJANZ XR IN THE LAST 720 DAYS REQ PRIOR AUTHORIZATION |
|
TRICARE Uniform Formulary 2026
via Xeljanz Xr |
Tier 2 - Brand Formulary | — | ✓ | — | ST Step therapy: XELJANZ,XELJANZ XR W/O USE OF BRAND XELJANZ, XELJANZ XR IN THE LAST 720 DAYS REQ PRIOR AUTHORIZATION |