Varies by plan

Does Mmm Healthcare, LLC require prior authorization for Xeljanz?

Prior authorization for Xeljanz differs across Mmm Healthcare, LLC'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	Qty limit	Status
tofacitinib 5 MG Oral Tablet [Xeljanz]1357547	20 / 20	20	20	Prior authorization required
24 HR tofacitinib 11 MG Extended Release Oral Tablet [Xeljanz]1741049	20 / 20	20	20	Prior authorization required
tofacitinib 10 MG Oral Tablet [Xeljanz]2048568	20 / 20	20	20	Prior authorization required
24 HR tofacitinib 22 MG Extended Release Oral Tablet [Xeljanz]2273115	20 / 20	20	20	Prior authorization required
tofacitinib 1 MG/ML Oral Solution [Xeljanz]2478437	0 / 20	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
MMM Balance (HMO-POS)	H4004-073	5	Yes	No	Yes
MMM Balance (HMO-POS)	H4004-073	5	Yes	No	Yes
MMM Balance (HMO-POS)	H4004-073	5	Yes	No	Yes
MMM Combo Platino (HMO D-SNP)	H4004-068	5	Yes	No	Yes
MMM Deluxe (HMO-POS)	H4003-055	5	Yes	No	Yes
MMM Diamante Platino (HMO D-SNP)	H4003-017	5	Yes	No	Yes
MMM Dorado Platino (HMO D-SNP)	H4003-058	5	Yes	No	Yes
MMM Elite (HMO-POS)	H4003-034	5	Yes	No	Yes
MMM Flexi Platino (HMO D-SNP)	H4004-069	5	Yes	No	Yes
MMM Grandioso (HMO-POS)	H4004-070	5	Yes	No	Yes
MMM Mega Flex (HMO-POS)	H4004-071	5	Yes	No	Yes
MMM Plenitud (HMO-POS)	H4004-065	5	Yes	No	Yes
MMM Relax Platino (HMO D-SNP)	H4004-072	5	Yes	No	Yes
MMM Relax Platino (HMO D-SNP)	H4004-072	5	Yes	No	Yes
MMM Relax Platino (HMO D-SNP)	H4004-072	5	Yes	No	Yes
MMM Supremo (HMO C-SNP)	H4003-009	5	Yes	No	Yes
MMM Unico (HMO-POS)	H4003-019	5	Yes	No	Yes
MMM Valioso (HMO-POS)	H4004-066	5	Yes	No	Yes
PMC Max (HMO-POS)	H4004-056	5	Yes	No	Yes
PMC Premier Platino (HMO D-SNP)	H4004-048	5	Yes	No	Yes

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

Or see Xeljanz across every payer at once.

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.