Xeljanz (tofacitinib)
Patient Assistance Program Guide — Pfizer Patient Assistance Program
Do You Qualify?
Income
Up to $60,240 for a single person
Insurance
Uninsured, underinsured, or Medicare Part D patients with a coverage gap; must not have other public or private prescription drug coverage.
Residency
U.S. resident or U.S. Territory resident
Income Limits (400% FPL)
Calculated based on 400% of the 2025 FPL for specialty products like Xeljanz.
Based on 2025 HHS Federal Poverty Level guidelines.
# Pfizer Patient Assistance Program for Xeljanz (Tofacitinib): A Complete Guide
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Who Qualifies for the Pfizer Patient Assistance Program?
If you cannot afford Xeljanz, you may be able to get it at no cost through the Pfizer Patient Assistance Program. This program is designed to help patients who lack adequate prescription drug coverage and meet income guidelines. For a single-person household, your annual income must be at or below $60,240 to qualify. You must not have active public or private prescription drug coverage — meaning this program is intended for people who are uninsured, underinsured, or Medicare Part D enrollees experiencing a coverage gap. If you meet these basic requirements, the program may provide Xeljanz to you free of charge, shipped directly to your home.
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About Xeljanz (Tofacitinib)
Xeljanz (tofacitinib) is a prescription medication made by Pfizer. It belongs to a drug class called JAK inhibitors, which work by targeting specific enzymes involved in immune system signaling. Pfizer has received FDA approval for Xeljanz to treat several conditions, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis, and polyarticular juvenile idiopathic arthritis. Without insurance or financial assistance, Xeljanz can cost several thousand dollars per month, placing it out of reach for many patients. As a brand-name specialty medication with no FDA-approved biosimilar alternatives currently on the market, there are limited lower-cost substitutes available, making patient assistance programs especially important for those who need this drug.
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Income Eligibility: Full Breakdown
Pfizer sets income limits based on 400% of the Federal Poverty Level (FPL). The table below shows the maximum annual household income allowed for each household size under the 2025 guidelines:
| Household Size | Maximum Annual Income |
|---|---|
| 1 person | $60,240 |
| 2 persons | $81,760 |
| 3 persons | $103,280 |
| 4 persons | $124,800 |
If your household is larger than four people, the limit increases with each additional member, so you should contact the program directly to confirm the threshold that applies to you.
Income is typically verified using your most recent federal tax return (Form 1040 or W-2), or three months of recent pay stubs if your income has changed since last year. If you are self-employed or have variable income, documentation requirements may differ — calling the program at (866) 706-2400 can help clarify what is acceptable.
If your income is above the limit for your household size, you may not qualify for this program. In that case, see the "Alternatives If You Don't Qualify" section below for other options that may help reduce your costs.
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Insurance Requirements Explained
Understanding how your current coverage affects eligibility is important before you apply.
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Step-by-Step: How to Apply
Follow these steps to submit your application for the Pfizer Patient Assistance Program:
1. Gather your documents. You will need: a completed application form with signatures from both you and your prescriber, proof of household income (such as your most recent Form 1040, W-2, or three months of pay stubs), and a valid prescription for Xeljanz.
2. Choose your application method. You can apply online, by phone, or by fax.
3. Apply online: Visit https://www.pfizerrxpathways.com to complete and submit your application digitally. This is often the fastest method.
4. Apply by phone: Call (866) 706-2400 to speak with a program representative who can guide you through the process or submit your information verbally.
5. Apply by fax: If your prescriber's office is submitting on your behalf, they can fax completed forms to (866) 471-4600.
6. Have your prescriber involved. Your doctor must sign the application. Many prescriber offices are familiar with this process and can help coordinate your submission.
7. Submit your income documents along with the application. Incomplete submissions will delay processing.
8. Wait for confirmation. Processing typically takes 2–3 business days once all documents are received.
For additional program information, visit https://www.xeljanz.com/support.
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What to Expect: Timeline and Delivery
Once Pfizer receives your complete application, processing typically takes 2–3 business days. You will be notified of your approval status, and approved patients receive their medication shipped directly to their home address — you do not need to pick it up at a pharmacy. Make sure your mailing address and delivery preferences are clearly noted on your application.
Your approval is valid for one year. Before that period ends, you will need to complete a reauthorization, which means submitting updated income documentation and a renewed prescription. Staying on top of this annual renewal helps ensure you do not experience a gap in your medication supply.
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Alternatives If You Don't Qualify
If you do not meet the income or insurance requirements for the Pfizer Patient Assistance Program, there are still options that may help.
1. Biosimilars: There are currently no FDA-approved biosimilars for Xeljanz (tofacitinib), so a lower-cost substitution is not available at this time.
2. Savings card for insured patients: If you have commercial insurance, Pfizer offers a savings card program that may reduce your out-of-pocket costs. You can learn more and enroll at https://www.xeljanz.com/xeljanz-savings-and-support.
3. State Pharmaceutical Assistance Programs (SPAPs): Many states offer their own drug assistance programs, particularly for seniors or people with disabilities. Eligibility and benefits vary by state. Contact your state health department or benefits office to ask about available programs.
4. NeedyMeds.org: This free, independent database at www.needymeds.org lists hundreds of assistance programs by drug name, condition, and state. It is a helpful starting point if you need to explore all available options.
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*This guide is for informational purposes only and does not constitute medical or legal advice. Eligibility determinations are made solely by Pfizer. Program terms may change — verify current requirements at [https://www.xeljanz.com/support](https://www.xeljanz.com/support) before applying.*
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Documents You'll Need
If You Don't Qualify for the Assistance Program
Manufacturer Savings Card (for insured patients)
Pfizer offers a savings card that may reduce your out-of-pocket cost if you have commercial insurance. Ask your prescriber or pharmacist for current savings card details.
Common Questions
Once Pfizer receives your complete application — including all required documents and signatures — processing typically takes 2 to 3 business days. After approval, your medication is shipped directly to your home. Total time from application to delivery may vary depending on how quickly all documents are submitted.
Yes. The Pfizer Patient Assistance Program requires annual reauthorization. Before your approval period ends, you will need to submit updated income documentation and a current prescription. It is a good idea to start the renewal process a few weeks before your approval expires to avoid any gap in coverage.
Yes. Many prescriber offices are familiar with this process and can help complete and submit the application on your behalf, including faxing forms to (866) 471-4600. However, both your signature and your doctor's signature are required on the application, so you will still need to be involved in that step.
Possibly. Medicare Part D patients may qualify if they are in the coverage gap, sometimes called the donut hole, or if their plan does not adequately cover Xeljanz. Patients with full, active Part D coverage for this drug are generally not eligible. Contact the program at (866) 706-2400 to discuss your specific situation.
Yes. If you have commercial insurance and do not qualify for the free medication program, Pfizer offers a savings card that may lower your copay or out-of-pocket costs. You can find details and sign up at https://www.xeljanz.com/xeljanz-savings-and-support.
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