Does Nextblue Of North Dakota Insurance Company require prior authorization for Xeljanz?
Prior authorization for Xeljanz differs across Nextblue Of North Dakota Insurance Company's Medicare Part D plans and product strengths — 3 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 | 2 / 2 | 2 | 0 | 2 | Prior authorization required |
| 24 HR tofacitinib 11 MG Extended Release Oral Tablet [Xeljanz]1741049 | 2 / 2 | 2 | 0 | 2 | Prior authorization required |
| tofacitinib 10 MG Oral Tablet [Xeljanz]2048568 | 2 / 2 | 2 | 0 | 2 | Prior authorization required |
| 24 HR tofacitinib 22 MG Extended Release Oral Tablet [Xeljanz]2273115 | 0 / 2 | 0 | 0 | 0 | Not on formulary |
| tofacitinib 1 MG/ML Oral Solution [Xeljanz]2478437 | 0 / 2 | 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 |
|---|---|---|---|---|---|
| NextBlue Discover PPO (PPO) | H6202-004 | 5 | Yes | No | Yes |
| NextBlue Summit PPO (PPO) | H6202-005 | 5 | Yes | No | Yes |
- 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.