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Xelsource Answers and Support for Xeljanz
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2730 S. Edmonds Lane, Suite 300,
Lewisville, TX 75067
Phone
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855-493-5526
Fax:
866-297-3471
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Eligibility
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Patients must be uninsured or underinsured. Medicare Part D recipients are also eligible. Income requirements for this program vary. Patients must live in the US. |
| Who Can Apply
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Patients or healthcare professionals can call to have an application mailed or download the application. |
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Required
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Doctors must complete a section of the application and sign. Patients must complete a section of the application, sign and attach proof of income. |
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Supply
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Varies |
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Ship To
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Varies |
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Note
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Xeljanz tablet |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
| Download printable Form |
| Download printable Form |
(Requires Acrobat Reader) 
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