Medicare Part D coverage · tofacitinib · RxCUI 2478437
tofacitinib 1 MG/ML Oral Solution [Xeljanz]
Per the CMS 2026 Part D formulary file, tofacitinib 1 MG/ML Oral Solution [Xeljanz] is covered by 3,081 Medicare Part D plans (61% of enrollable products), averaging Tier 4.1, with prior authorization required on 98.4% of covering formularies.
- 61%
- Plan coverage
- 3,081
- Plans covering
- T4.1
- Avg tier
- 98.4%
- Prior auth required
What the CMS Formulary Data Shows for tofacitinib 1 MG/ML Oral Solution [Xeljanz]
Per the CMS 2026 Part D formulary file, tofacitinib 1 MG/ML Oral Solution [Xeljanz] (RxNorm concept RXCUI 2478437, generic name tofacitinib) appears on 257 distinct formulary files spanning 3,081 Medicare Part D plan offerings - 61% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.1.
Real-world access to tofacitinib 1 MG/ML Oral Solution [Xeljanz] depends on utilization management as much as tier placement: 98.4% of covering formularies require prior authorization. 0% require step therapy. 75.1% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 12,497 Part D beneficiaries filled tofacitinib 1 MG/ML Oral Solution [Xeljanz] in 2023, with total plan-and-beneficiary spending of $585,772,572 and an average per-beneficiary annual cost of $46,873.06. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry tofacitinib 1 MG/ML Oral Solution [Xeljanz] today.
Coverage Details
- Formularies covering
- 257
- Plans covering
- 3,081
- Coverage rate
- 61%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 98.4% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 75.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 12,497
- Total spending
- $585,772,572
- Avg per beneficiary
- $46,873.06
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering tofacitinib 1 MG/ML Oral Solution [Xeljanz]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | Yes | $0 | FL |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | Yes | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | Yes | $0 | MA |
Show the next 30 plans
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | Yes | $0 | MA |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | Yes | $0 | MA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | Yes | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | Yes | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | Yes | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | Yes | $0 | MO |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | Yes | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | Yes | $0 | PR |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | Yes | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is tofacitinib 1 MG/ML Oral Solution [Xeljanz] covered by Medicare Part D?
Yes, tofacitinib 1 MG/ML Oral Solution [Xeljanz] is covered by 3,081 Medicare Part D plans (61% of all Part D formularies).
What tier is tofacitinib 1 MG/ML Oral Solution [Xeljanz] on Medicare Part D plans?
tofacitinib 1 MG/ML Oral Solution [Xeljanz] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does tofacitinib 1 MG/ML Oral Solution [Xeljanz] require prior authorization?
98.4% of Part D formularies require prior authorization for tofacitinib 1 MG/ML Oral Solution [Xeljanz]. Step therapy: 0%. Quantity limits: 75.1%.
How much does Medicare spend on tofacitinib 1 MG/ML Oral Solution [Xeljanz]?
In 2023, total Medicare Part D spending on tofacitinib 1 MG/ML Oral Solution [Xeljanz] was $585,772,572, covering 12,497 beneficiaries. The average spend per beneficiary was $46,873.06.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
Similar prior-authorization rate
- epoetin alfa-epbx 20000 UNT/ML Injectable Solution [Retacrit] 98.4% PA
- alanine 20.7 MG/ML / arginine 11.5 MG/ML / glycine 10.3 MG/ML / histidine 4.8 MG/ML / isoleucine 6 MG/ML / leucine 7.3 MG/ML / lysine 5.8 MG/ML / methionine 4 MG/ML / phenylalanine 5.6 MG/ML / proline 6.8 MG/ML / serine 5 MG/ML / threonine 4.2 MG/ML / tryptophan 1.8 MG/ML / tyrosine 0.4 MG/ML / valine 5.8 MG/ML Injectable Solution [Travasol 10] 98.4% PA
- 1.7 ML denosumab-bnht 70 MG/ML Injection [Bomyntra] 98.4% PA
- 1.7 ML denosumab-bnht 70 MG/ML Prefilled Syringe [Bomyntra] 98.4% PA
- risdiplam 5 MG Oral Tablet [Evrysdi] 98.4% PA
- arimoclomol 124 MG Oral Capsule [Miplyffa] 98.4% PA