Varies by plan
Does Blue Cross Blue Shield (affiliate) require prior authorization for Xeljanz?
Prior authorization for Xeljanz differs across Blue Cross Blue Shield (affiliate)'s Medicare Part D plans and product strengths — 4 of 5 Xeljanz products in the corpus appear on their formularies, and the requirement is not uniform. Check the member's specific plan.
Some plans require authorization and others do not. The member's specific plan decides.
- This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| tofacitinib 5 MG Oral Tablet [Xeljanz]1357547 | 201 / 269 | 201 | 0 | 201 | Prior authorization required |
| 24 HR tofacitinib 11 MG Extended Release Oral Tablet [Xeljanz]1741049 | 201 / 269 | 201 | 0 | 201 | Prior authorization required |
| tofacitinib 10 MG Oral Tablet [Xeljanz]2048568 | 201 / 269 | 201 | 0 | 201 | Prior authorization required |
| 24 HR tofacitinib 22 MG Extended Release Oral Tablet [Xeljanz]2273115 | 169 / 269 | 169 | 0 | 169 | Prior authorization required |
| tofacitinib 1 MG/ML Oral Solution [Xeljanz]2478437 | 0 / 269 | 0 | 0 | 0 | Not on formulary |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — tofacitinib 5 MG Oral Tablet [Xeljanz]
Xeljanz has 5 products in the corpus; this table is for tofacitinib 5 MG Oral Tablet [Xeljanz], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Anthem Dual Advantage (HMO D-SNP) | H5422-018 | 5 | Yes | No | Yes |
| Anthem Extra Help (HMO-POS) | H5422-013 | 5 | Yes | No | Yes |
| Anthem Full Dual Advantage (HMO D-SNP) | H5422-019 | 5 | Yes | No | Yes |
| Anthem Full Dual Advantage Aligned (HMO D-SNP) | H4471-010 | 5 | Yes | No | Yes |
| Anthem Full Dual Advantage Aligned (HMO D-SNP) | H4471-010 | 5 | Yes | No | Yes |
| Anthem Full Dual Advantage Aligned (HMO D-SNP) | H4471-011 | 5 | Yes | No | Yes |
| Anthem I CareMore Chronic Care (HMO-POS C-SNP) | H0544-004 | 5 | Yes | No | Yes |
| Anthem I CareMore Chronic Care (HMO-POS C-SNP) | H0544-010 | 5 | Yes | No | Yes |
| Anthem I CareMore Chronic Care 2 (HMO-POS C-SNP) | H4161-014 | 5 | Yes | No | Yes |
| Anthem I CareMore Chronic Care 2 (HMO-POS C-SNP) | H4161-015 | 5 | Yes | No | Yes |
| Anthem I CareMore Home Care (HMO I-SNP) | H0544-005 | 5 | Yes | No | Yes |
| Anthem I CareMore Kidney Care (HMO-POS C-SNP) | H0544-015 | 5 | Yes | No | Yes |
| Anthem I CareMore Kidney Care (HMO-POS C-SNP) | H0544-020 | 5 | Yes | No | Yes |
| Anthem I CareMore Lung Care (HMO-POS C-SNP) | H0544-014 | 5 | Yes | No | Yes |
| Anthem I CareMore Lung Care (HMO-POS C-SNP) | H0544-019 | 5 | Yes | No | Yes |
| Anthem I CareMore Lung Care 2 (HMO-POS C-SNP) | H4161-016 | 5 | Yes | No | Yes |
| Anthem I CareMore Lung Care 2 (HMO-POS C-SNP) | H4161-017 | 5 | Yes | No | Yes |
| Anthem I CareMore Medicare Advantage (HMO-POS) | H4161-011 | 5 | Yes | No | Yes |
| Anthem I CareMore Medicare Advantage (HMO-POS) | H4161-013 | 5 | Yes | No | Yes |
| Anthem I CareMore Medicare Advantage 2 (HMO-POS) | H0544-002 | 5 | Yes | No | Yes |
| Anthem I CareMore Premium Savings (HMO-POS) | H4161-012 | 5 | Yes | No | Yes |
| Anthem Kidney Care (HMO-POS C-SNP) | H5422-015 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-056 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-061 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-062 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-063 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-064 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-065 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-095 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-096 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H0544-108 | 5 | Yes | No | Yes |
| Anthem Medicare Advantage (HMO-POS) | H5422-011 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-002 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-003 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-004 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-005 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-006 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-007 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-009 | 5 | Yes | No | Yes |
| Anthem Prime (HMO-POS) | H4161-010 | 5 | Yes | No | Yes |
| Anthem Select (HMO-POS) | H0544-058 | 5 | Yes | No | Yes |
| Anthem Select (HMO-POS) | H0544-066 | 5 | Yes | No | Yes |
| Anthem Select (HMO-POS) | H0544-069 | 5 | Yes | No | Yes |
| Anthem Select (HMO-POS) | H0544-091 | 5 | Yes | No | Yes |
| Anthem Select (HMO-POS) | H0544-098 | 5 | Yes | No | Yes |
| CareFirst BlueCross BlueShield Advantage Complete (PPO) | H7379-002 | 5 | Yes | No | Yes |
| CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) | H8854-002 | 5 | Yes | No | Yes |
| CareFirst BlueCross BlueShield Advantage Essential (PPO) | H7379-001 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3384-070 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Distinct (HMO) | H3957-049 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Merit (HMO) | H3384-071 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3384-069 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3384-069 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3384-069 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-042 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | Yes |
| Community Blue Medicare HMO Signature (HMO) | H3957-047 | 5 | Yes | No | Yes |
| Community Blue Medicare Plus PPO Signature (PPO) | H3916-039 | 5 | Yes | No | Yes |
| Community Blue Medicare Plus PPO Signature (PPO) | H3916-063 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-037 | 5 | Yes | No | Yes |
| Community Blue Medicare PPO Signature (PPO) | H3916-065 | 5 | Yes | No | Yes |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | Yes |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | Yes |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | Yes |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | Yes |
| Complete Blue HMO Distinct (HMO) | H3957-050 | 5 | Yes | No | Yes |
| Complete Blue Plus PPO Distinct (PPO) | H3916-061 | 5 | Yes | No | Yes |
| Complete Blue Plus PPO Distinct (PPO) | H3916-061 | 5 | Yes | No | Yes |
| Complete Blue Plus PPO Merit (PPO) | H3916-064 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-035 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-035 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-059 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-059 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
| Complete Blue PPO Distinct (PPO) | H3916-060 | 5 | Yes | No | Yes |
Showing 100 of 201 covering plans.
Source
Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — Basic Drugs Formulary File- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.
Xeljanz at other payers
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.