Western Health Advantage
Xeljanz (tofacitinib)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Available through Specialty Pharmacy;
  • Step Therapy: Rheumatoid Arthritis (RA):
    ST Single Generic

  • Quantity Limit: 30 day supply per 1 fill(s).
  • Prior Authorization: Rheumatoid Arthritis (RA):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 1 year(s)

  • PA Required
  • Rheumatoid Arthritis (RA):
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Rheumatologist
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    TB Test required: Yes

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