XELSOURCE Patient Assistance Program Application 1 Phone 1-844-XELJANZ (1-844-935-5269) • Fax 1-866-297-3471 • 2730 S. Edmonds Lane, Suite 300, Lewisville, TX 75067
Full Answer
What is the coverage for Xeljanz?
XELJANZ is covered for 99% of commercially-insured, moderate to severe rheumatoid arthritis patients with a prescription. †‡ * The Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance Foundation™.
How do I Activate my xelsource card?
Follow the directions to print a card or save it to your digital wallet immediately after registering. To activate your card, call 1-844-935-5269 and say “Activate.” * For eligible underinsured or uninsured patients, XELSOURCE may offer financial assistance through the Pfizer Patient Assistance Program.
How do I enroll patients in xelsource HCP?
Contact your Pfizer Representative to be put in touch with your FRM See how the XELSOURCE HCP Portal streamlines the enrollment processFind out more about XELSOURCEForms and resources to help eligible patients access their prescribed medicationXELSOURCE Prescription and Enrollment Form Complete, print, and fax to enroll patients in XELSOURCE.
How do I contact Xeljanz?
Phone 1-844-XELJANZ (1-844-935-5269) • Fax 1-866-297-3471 • 2730 S. Edmonds Lane, Suite 300, Lewisville, TX 75067 Patient Declaration– By signing below, I affirm that my answers and my proof-of-income documents are complete, true, and accurate to the best of my knowledge.
How to contact XELSOURCE?
How to speak with someone at XELSOURCE?
What is the phone number for Xeljanz?
Can you save on Xeljanz?
How to receive XSAVINGS?
Can you get XELJANZ if you don't have insurance?
Can XELSOURCE change your health insurance?
See 4 more
About this website
What is Xelsource?
Psoriatic Arthritis. • XELJANZ/XELJANZ XR (tofacitinib) is indicated for the treatment of adult patients with active psoriatic arthritis who have had an inadequate response or intolerance to methotrexate or other disease-modifying antirheumatic drugs (DMARDs).
What is Pfizer patient assistance program?
Pfizer Patient Assistance Program Provides free Pfizer medicines to eligible patients through their doctor's office or at home.
Does Organon have a patient assistance program?
THE ORGANON PATIENT ASSISTANCE PROGRAM FOR RENFLEXIS The Organon Patient Assistance Program provides certain Organon medicines free of charge to eligible patients. The Organon Access Program representative can refer you to the Organon Patient Assistance Program for eligibility determination.
Is patient assistance program legitimate?
Patient assistance programs (PAPs) are usually sponsored by pharmaceutical manufacturers and are promoted as a safety net for Americans who have no health insurance or are underinsured.
How do you qualify for free eliquis?
You may be eligible for the Free 30-Day Trial Offer for ELIQUIS® (apixaban) if:You have not previously filled a prescription for ELIQUIS;You have a valid 30-day prescription for ELIQUIS;You are being treated with ELIQUIS for an FDA-approved indication that an HCP has planned for more than 35 days of treatment;More items...
What is Pfizer connect?
The Pfizer Patient Assistance Program provides certain medicines for free to eligible financially needy insured and uninsured patients.
How can I get a free inhaler?
Prescription assistance programs (PAPs) are designed to provide inhalers and other asthma drugs free of charge or at a highly discounted price to lower-income individuals and families. Copay assistance programs (CAPs) cover a portion of drug copay costs for people with health insurance.
What products does Organon make?
US Organon ProductsASMANEX® HFA. (mometasone furoate) 50 mcg, 100 mcg, 200 mcg Inhalation Aerosol. ... ASMANEX® TWISTHALER® (mometasone furoate inhalation powder) 110 mcg, 220 mcg. ... DULERA® ... FOLLISTIM® AQ Cartridge. ... Ganirelix Acetate Injection. ... NEXPLANON® ... An Organon Biosimilars Product. ... PREGNYL®More items...
What is harmony by Organon?
The HARMONY BY ORGANON Patient Support Program provides support services, including coordination with private payers (for patients taking Renflexis, Brenzys or Hadlima) and infusion centres (for patients taking Renflexis).
Can you use copay assistance with Medicare?
The Patient Advocate Foundation (PAF) Co-Pay Relief Program (CPR) provides direct financial support for pharmaceutical co-payments to insured patients, including Medicare Part D beneficiaries, who financially and medically qualify.
How do patient support programs work?
A patient assistance or support programs (PAPs or PSPs) exist to get you timely access to medication and to help you stay on track of your therapy. Being diagnosed with a complex disease or condition may come with unexpected financial burden and a need to better understand treatment options and next steps.
What are the income limits for GSK patient assistance program?
You must also meet certain household income eligibility requirements as outlined below:48 States and DCHousehold SizeMaximum Monthly Gross Income1$2,831.252$3,814.583$4,797.924 more rows
What is Pfizer enCompass?
Pfizer enCompass offers various services to patients including reimbursement support for insured patients; co-pay assistance for eligible commercially insured patients who cannot afford their co-pays, co-insurances, or deductibles; and a free medicine patient assistance program for eligible uninsured or underinsured ...
What is Pfizer Oncology together?
Pfizer Oncology Together is a personalized patient support program that offers resources for patients prescribed Pfizer Oncology medicines. We provide access and reimbursement support, as well as help identifying financial assistance options, so patients can get their prescribed Pfizer Oncology medicines.
Does Viatris have a patient assistance program?
The Viatris Patient Assistance Program provides certain medicines for free to patients with demonstrated financial need. Viatris is committed to helping patients get the treatments they need, when and where they need them.
Does Chantix have a patient assistance program?
for Consumers: Visit the CHANTIX consumer Web site to learn more about this medication and the GETQUIT patient support program.
Xeljanz Prices, Coupons, Copay & Patient Assistance - Drugs.com
Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include IBM Watson Micromedex (updated 1 Sep 2022), Cerner Multum™ (updated 21 Sep 2022), ASHP (updated 12 Sep 2022 ...
Does Medicare Cover Xeljanz? | Medicare Prescription Drug Coverage
Does Medicare cover Xeljanz? Yes! 69% of Medicare Advantage plans and Medicare Part D plans cover Xeljanz. 1 Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD).Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs. 2Medicare prescription drugs plans each have their own formulary, or drug list, that ...
PATIENT ASSISTANCE APPLICATION FOR XELJANZ® (tofacitinib ... - RxHope
Patient Declaration – By signing below, I affirm that my answers and my proof-of-income documents are complete, true, and accurate to the best of my knowledge. I understand that: • Completing this application form does not guarantee that I will qualify
XELSOURCE Patient Assistance Program Application - Pfizer pro
1 PATIENT APPLICATION PFIZER PATIENT ASSISTANCE PROGRAM* Phone 1-844-935-5269 | Fax 1-866-297-3471 | 2730 S. Edmonds Lane, Suite 300, Lewisville TX 75067
Xeljanz XR Medicare Coverage and Co-Pay Details - GoodRx
Medicare coverage and pricing details for Xeljanz XR. Learn more about Medicare prescription drug plans and savings with GoodRx.
What are the most common adverse reactions to Xeljanz?
The most commonly reported adverse reactions during the first 3 months in controlled clinical trials with XELJANZ 5 mg twice daily and placebo, respectively, (occurring in greater than or equal to 2% of patients treated with XELJANZ with or without DMARDs) were upper respiratory tract infections (4.5%, 3.3%), headache (4.3%, 2.1%), diarrhea (4.0%, 2.3%), and nasopharyngitis (3.8%, 2.8%).
What does XELJANZ XR look like?
When you take XELJANZ XR, you may see something in your stool that looks like a tablet. This is the empty shell from the tablet after the medicine has been absorbed by your body.
Does XELJANZ inhibit gastrointestinal perforation?
Gastrointestinal perforations have been reported in XELJANZ clinical trials, although the role of JAK inhibition is not known. XELJANZ/XELJANZ XR should be used with caution in patients who may be at increased risk for gastrointestinal perforation (e.g., patients with a history of diverticulitis).
Can Xeljanz cause TB?
XELJANZ/XELJANZ XR may cause serious side effects, including:Serious infections. XELJANZ/XELJANZ XR can lower the ability of your immune system to fight infections. Some people can have serious infections while taking XELJANZ/XELJANZ XR, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during XELJANZ/XELJANZ XR treatment, and monitor you closely for signs and symptoms of TB infection during treatment. You should not start taking XELJANZ/XELJANZ XR if you have any kind of infection unless your healthcare provider tells you it is okay.
Can XELJANZ XR be administered with strictures?
Caution should be used when administering XELJANZ XR to patients with pre-existing severe gastrointestinal narrowing. There have been rare reports of obstructive symptoms in patients with known strictures in association with the in gestion of other drugs utilizing a non-deformable extended release formulation.
How to contact XELSOURCE?
Commercial patients prescribed XELJANZ or XELJANZ XR should call XELSOURCE at 1-844-935-5269 to determine if they qualify for a Co-Pay Savings Card. Terms and conditions can be accessed here.
How to speak with someone at XELSOURCE?
To speak with someone at XELSOURCE about your insurance coverage and medication costs for XELJANZ or XELJANZ XR , call 1-844-935-5269 and say “Representative.”. XELJANZ is covered for 98% of commercially-insured, moderate to severe rheumatoid arthritis patients with a prescription. †‡.
What is the phone number for Xeljanz?
To speak to someone at XELSOURCE about your insurance coverage and medication costs for XELJANZ or XELJANZ XR, Monday through Friday, 8:00 AM - 8:00 PM ET, call 1-844-935-5269 and say “Representative.”.
Can you save on Xeljanz?
Savings may be just a phone call away. If you have a financial hardship and you’ve been prescribed XELJANZ or XELJANZ XR, call XELSOURCE to learn how you may be able to save on your XELJANZ prescription. See below for details. Terms and conditions/eligibility requirements apply.
How to receive XSAVINGS?
Elect to receive one via text message by texting “XPROGRAM” to 50336 and enrolling in the XSAVINGS Co-Pay Program for XELJANZ. †
Can you get XELJANZ if you don't have insurance?
If turned down, we will evaluate you for the Pfizer Patient Assistance Program. If you are eligible, we will provide you XELJANZ or XELJANZ XR at no cost to you. See limits, terms, and conditions.
Can XELSOURCE change your health insurance?
Health plans can change—so can your health insurance and prescription benefits. Once your new plan begins, XELSOURCE can help review your plan information, verify your coverage if needed, and assist with the Prior Authorization (PA) process.
What is Xeljanz used for?
XELJANZ® (tofacitinib citrate) is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response or intolerance to methotrexate. It may be used as monotherapy or in combination with methotrexate or other nonbiologic disease-modifying antirheumatic drugs (DMARDs).
What infections are associated with Xeljanz?
The most common serious infections reported with XELJANZ included pneumonia, cellulitis, herpes zoster, and urinary tract infection . Avoid use of XELJANZ in patients with an active, serious infection, including localized infections. Consider the risks and benefits of treatment before initiating XELJANZ in patients:
What is an attached authorization?
The attached Authorization, when signed by your patient, documents the patient’s permission for you to share certain medical and personal information with Pfizer in connection with Pfizer’s patient assistance programs. This Authorization is strictly for your records and should not be returned with your patient’s application.
What are the most common adverse reactions to Xeljanz?
The most commonly reported adverse reactions during the first 3 months in controlled clinical trials with XELJANZ 5 mg twice daily and placebo, respectively, (occurring in greater than or equal to 2% of patients treated with XELJANZ with or without DMARDs) were upper respiratory tract infections (4.5%, 3.3%), headache (4.3%, 2.1%), diarrhea (4.0%, 2.3%), and nasopharyngitis (3.8%, 2.8%).
Can Xeljanz cause TB?
Serious infections. XELJANZ can lower the ability of your immune system to fight infections. Some people have serious infections while taking XELJANZ, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting XELJANZ, and monitor you closely for signs and symptoms of TB infection during treatment. You should not start taking XELJANZ if you have any kind of infection unless your healthcare provider tells you it is okay.Before starting XELJANZ, tell your healthcare provider if you:
How to contact XELSOURCE?
Commercial patients prescribed XELJANZ or XELJANZ XR should call XELSOURCE at 1-844-935-5269 to determine if they qualify for a Co-Pay Savings Card. Terms and conditions can be accessed here.
How to speak with someone at XELSOURCE?
To speak with someone at XELSOURCE about your insurance coverage and medication costs for XELJANZ or XELJANZ XR , call 1-844-935-5269 and say “Representative.”. XELJANZ is covered for 98% of commercially-insured, moderate to severe rheumatoid arthritis patients with a prescription. †‡.
What is the phone number for Xeljanz?
To speak to someone at XELSOURCE about your insurance coverage and medication costs for XELJANZ or XELJANZ XR, Monday through Friday, 8:00 AM - 8:00 PM ET, call 1-844-935-5269 and say “Representative.”.
Can you save on Xeljanz?
Savings may be just a phone call away. If you have a financial hardship and you’ve been prescribed XELJANZ or XELJANZ XR, call XELSOURCE to learn how you may be able to save on your XELJANZ prescription. See below for details. Terms and conditions/eligibility requirements apply.
How to receive XSAVINGS?
Elect to receive one via text message by texting “XPROGRAM” to 50336 and enrolling in the XSAVINGS Co-Pay Program for XELJANZ. †
Can you get XELJANZ if you don't have insurance?
If turned down, we will evaluate you for the Pfizer Patient Assistance Program. If you are eligible, we will provide you XELJANZ or XELJANZ XR at no cost to you. See limits, terms, and conditions.
Can XELSOURCE change your health insurance?
Health plans can change—so can your health insurance and prescription benefits. Once your new plan begins, XELSOURCE can help review your plan information, verify your coverage if needed, and assist with the Prior Authorization (PA) process.
