Is Xeljanz Covered By Medicare?

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As one ages, the risk of developing chronic illnesses and conditions increases. This is where health insurance, particularly Medicare, plays a crucial role in ensuring that one can access affordable medical care. One such medication that has garnered attention in recent years is Xeljanz, a drug used to treat rheumatoid arthritis and other autoimmune diseases. However, the question remains: is Xeljanz covered by Medicare?

Xeljanz, manufactured by Pfizer, is an oral medication that works by inhibiting the activity of certain enzymes in the body that cause inflammation. While it is effective in treating rheumatoid arthritis and other autoimmune diseases, it can also come at a hefty price. This is particularly true for those who rely solely on Medicare for their healthcare needs. As such, it is vital to determine whether Xeljanz is covered by Medicare, and if so, under what conditions. In this article, we will delve into the complexities of Xeljanz coverage under Medicare, and explore the options available for those who require this medication.

Is Xeljanz Covered by Medicare?

Is Xeljanz Covered by Medicare?

Xeljanz (tofacitinib) is a medication approved by the FDA for the treatment of rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. It is an immunosuppressant drug that works by blocking certain enzymes in the body that cause inflammation. Many seniors rely on Medicare for their healthcare coverage, and they may be wondering if Xeljanz is covered by Medicare. In this article, we will explore the coverage options for Xeljanz under Medicare.

H3: Medicare Part B Coverage for Xeljanz

Medicare Part B covers some outpatient prescription drugs, including those that are administered in a doctor’s office or outpatient setting. Xeljanz falls under this category, as it is typically administered by a healthcare professional. However, Medicare Part B coverage for Xeljanz is limited to certain conditions, such as rheumatoid arthritis and psoriatic arthritis. Ulcerative colitis is not currently covered under Medicare Part B.

For those with rheumatoid arthritis or psoriatic arthritis, Xeljanz may be covered under Medicare Part B if it is deemed medically necessary by the prescribing physician. However, there may be specific requirements in order to qualify for coverage, such as trying other medications first or meeting certain clinical criteria. It is important to speak with a healthcare professional and a Medicare representative to determine coverage options.

H3: Medicare Part D Coverage for Xeljanz

Medicare Part D is a prescription drug plan that provides coverage for a wide range of medications. Xeljanz is typically covered under Medicare Part D, but coverage may vary depending on the specific plan. It is important to review the formulary of a Medicare Part D plan to determine if Xeljanz is covered and at what cost.

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If Xeljanz is not covered under a particular Medicare Part D plan, there may be other medications that are similar in nature that are covered. It is important to speak with a healthcare professional and a Medicare representative to determine the best course of action.

H3: Medicare Advantage Coverage for Xeljanz

Medicare Advantage plans, also known as Medicare Part C, are offered by private insurance companies and provide all the same coverage as Original Medicare (Part A and Part B) plus additional benefits. Medicare Advantage plans may have different coverage options for Xeljanz depending on the plan.

Some Medicare Advantage plans may offer coverage for Xeljanz under Part B or Part D benefits. However, it is important to review the specific plan’s formulary and speak with a healthcare professional and a Medicare representative to determine coverage options.

H3: Cost of Xeljanz Under Medicare

The cost of Xeljanz under Medicare can vary depending on the coverage option chosen. Under Medicare Part B, the cost is typically 20% of the Medicare-approved amount after the Part B deductible is met. Under Medicare Part D, the cost can vary depending on the specific plan and coverage.

It is important to review the cost of Xeljanz under each coverage option and consider any copayments, deductibles, and coinsurance before making a decision. There may also be financial assistance programs available for those who qualify.

H3: Benefits of Xeljanz

Xeljanz has been shown to be effective in the treatment of rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. It can help reduce inflammation and improve symptoms, such as joint pain and stiffness. It is important to speak with a healthcare professional to determine if Xeljanz is the right treatment option for an individual’s specific condition.

H3: Xeljanz vs. Other Medications

There are other medications available for the treatment of rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. It is important to speak with a healthcare professional to determine which medication is the best option based on an individual’s specific condition and medical history.

H3: Side Effects of Xeljanz

Like all medications, Xeljanz can have side effects. Common side effects include headache, diarrhea, and upper respiratory tract infections. More serious side effects can include infections, blood clots, and cancer. It is important to speak with a healthcare professional to understand the potential risks and benefits of Xeljanz.

H3: Conclusion

Xeljanz is a medication approved by the FDA for the treatment of rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. Coverage for Xeljanz under Medicare can vary depending on the coverage option chosen. It is important to review the specific coverage options and speak with a healthcare professional and a Medicare representative to determine the best course of action.

Frequently Asked Questions

Is Xeljanz covered by Medicare?

Yes, Xeljanz is covered by Medicare Part D prescription drug plans. However, the amount of coverage and cost may vary depending on the specific plan you are enrolled in. It is important to check with your plan provider to determine the amount of coverage and any out-of-pocket costs you may incur.

Xeljanz is classified as a specialty drug, which means it may have higher out-of-pocket costs than other medications. Some Medicare plans may require prior authorization or step therapy before covering Xeljanz. It is important to review your plan’s formulary and coverage policies to ensure Xeljanz is covered under your plan and to minimize your out-of-pocket costs.

What is Xeljanz used for?

Xeljanz (tofacitinib) is a medication used to treat moderate to severe rheumatoid arthritis (RA) in adults. It works by reducing inflammation and improving joint function. Xeljanz may be used alone or in combination with other RA medications.

In addition to RA, Xeljanz has also been approved by the FDA to treat psoriatic arthritis and ulcerative colitis. It is important to note that Xeljanz may have serious side effects, including an increased risk of infections, cancer, and blood clots. It is important to discuss the risks and benefits of Xeljanz with your healthcare provider before starting or continuing treatment.

What is the cost of Xeljanz without insurance?

The cost of Xeljanz without insurance can vary depending on the dosage, quantity, and pharmacy you use. On average, the cost of Xeljanz can range from $5,000 to $6,000 for a 30-day supply. However, some pharmacies may offer discounts or coupons to help reduce the cost.

If you do not have insurance or cannot afford the cost of Xeljanz, you may be eligible for financial assistance through Pfizer’s Patient Assistance Program or other charitable organizations. It is important to discuss your options with your healthcare provider and the manufacturer of Xeljanz to determine the best course of action for your situation.

What are the common side effects of Xeljanz?

The most common side effects of Xeljanz include upper respiratory infections, headache, diarrhea, and nasopharyngitis (inflammation of the nose and throat). Other side effects may include increased cholesterol levels, liver enzyme abnormalities, and anemia.

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Xeljanz may also increase the risk of serious infections, including tuberculosis and herpes zoster. It may also increase the risk of cancer and blood clots. It is important to discuss any side effects or concerns with your healthcare provider and to monitor your condition regularly while taking Xeljanz.

Can Xeljanz be taken with other medications?

Xeljanz may be taken alone or in combination with other medications to treat rheumatoid arthritis, psoriatic arthritis, or ulcerative colitis. However, it is important to discuss any medications you are taking with your healthcare provider to ensure there are no potential interactions.

Xeljanz may interact with certain medications, including immunosuppressants, live vaccines, and drugs that affect liver function. It is important to inform your healthcare provider of all medications, vitamins, and supplements you are taking before starting Xeljanz. Your healthcare provider may adjust the dosage or frequency of your medication to minimize the risk of side effects or interactions.

As a professional writer, it is clear that the question of whether Xeljanz is covered by Medicare is a topic of great concern for many individuals. There are a variety of factors that come into play when determining whether or not a particular medication is covered by Medicare, including its classification, the specific plan an individual is on, and the overall cost of the drug. While the answer may vary depending on these factors, it is important for individuals to do their research and understand their options when it comes to accessing healthcare.

Ultimately, the decision of whether or not to cover Xeljanz under Medicare is one that will continue to be debated and discussed in the years to come. As the healthcare landscape continues to evolve, it is important for individuals to stay informed and advocate for their own health and wellness. Whether navigating the complexities of Medicare coverage or seeking out alternative forms of treatment, the most important thing is to prioritize one’s own health and well-being above all else. With the right information and resources, anyone can take charge of their own healthcare journey and find the solutions that work best for them.

Meet Rakibul Hasan, the visionary leader and founder of Freeinsurancetips. With over a decade of experience in the insurance sector, Rakibul is dedicated to empowering individuals to make well-informed decisions. Guided by his passion, he has assembled a team of seasoned insurance professionals committed to simplifying the intricate world of insurance for you.

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