Does Wellpoint Health Plans, INC. require prior authorization for Xeljanz?
Wellpoint Health Plans, INC. requires prior authorization for Xeljanz on every Medicare Part D plan of theirs that covers it.
Every plan from this payer that covers the drug requires authorization before it is dispensed.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| tofacitinib 5 MG Oral Tablet [Xeljanz]1357547 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
| 24 HR tofacitinib 11 MG Extended Release Oral Tablet [Xeljanz]1741049 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
| tofacitinib 10 MG Oral Tablet [Xeljanz]2048568 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
| 24 HR tofacitinib 22 MG Extended Release Oral Tablet [Xeljanz]2273115 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
| tofacitinib 1 MG/ML Oral Solution [Xeljanz]2478437 | 7 / 7 | 7 | 0 | 7 | Prior authorization required |
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 |
|---|---|---|---|---|---|
| Wellpoint Chronic Care (HMO-POS C-SNP) | H1423-002 | 5 | Yes | No | Yes |
| Wellpoint I CareMore Home Care (HMO I-SNP) | H1423-007 | 5 | Yes | No | Yes |
| Wellpoint I CareMore Home Care (HMO I-SNP) | H1423-008 | 5 | Yes | No | Yes |
| Wellpoint Lung Care (HMO-POS C-SNP) | H1423-001 | 5 | Yes | No | Yes |
| Wellpoint Medicare Advantage (HMO-POS) | H1423-009 | 5 | Yes | No | Yes |
| Wellpoint Medicare Advantage 1 (HMO-POS) | H1423-004 | 5 | Yes | No | Yes |
| Wellpoint Premium Savings (HMO) | H1423-005 | 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.