Tofacitinib coverage
Last updated: April 6, 2023
BC PharmaCare coverage is changing for Xeljanz® and Xeljanz XR®.
Effective April 6, 2023, generic tofacitinib 5 mg and 10 mg tablets will be added to the PharmaCare formulary with the same Limited Coverage criteria currently in place for the brand name formulation of tofacitinib, Xeljanz® and Xeljanz XR®.
Patients with Special Authority coverage of Xeljanz who want to retain full coverage of tofacitinib will need to switch to a generic by May 5, 2023. This is the usual process when PharmaCare starts to cover a generic version of a drug.
After May 5, 2023, Xeljanz 5 mg and 10 mg tablets, and Xeljanz XR 11 mg tablets will become partial benefits under the Low-Cost Alternative (LCA) program. If a person has not switched to a generic by then, they will pay the price difference between the brand name product and the generic product.
Patients taking Xeljanz XR 11 mg once daily to treat rheumatoid arthritis can be switched to generic tofacitinib 5 mg taken twice a day in order to retain coverage. If patients choose to continue taking Xeljanz XR 11 mg, with Special Authority approval, PharmaCare will provide partial coverage (up to the cost of 2 x tofacitinib 5 mg tablets daily).
Prescribers can request a list of their patients who have filled a prescription for tofacitinib in the past six months by submitting a Tofacitinib Patient List Request.
Now that PharmaCare covers generic versions of tofacitinib, the yearly per-patient cost of tofacitinib at the pharmacy will decrease from approximately $18,000 to $4,500. Cost savings like this allow PharmaCare to cover new drugs and to keep the program strong.
Coverage under Fair PharmaCare
Coverage for brand name and generic tofacitinib under Fair PharmaCare will still depend on whether patients have met their annual deductible and family maximum.
Coverage under the Xeljanz Patient Support Program
Patients receiving coverage through the Xeljanz Patient Support Program may be able to get coverage through a patient support program for a generic version. See contact info below.
Resources
- Tofacitinib Patient List Request
- Tofacitinib generic listing in the April 2023 PharmaCare Newsletter
- LCA program (includes pricing exception for partial coverage of Xeljanz 11 mg)
- LCA and RDP program data files
- Tofacitinib patient info sheet
- Patient support programs for tofacitinib generics:
Auro
AuroCare+ Patient Support Program
T: 1-866-845-4354
F: 1-833-876-5930
AuroCare@supportprogram.com
Pharmascience
Ally Patient Support Program
PMS-tofacitinib
T: 1-833-654-2010
F: 1-833-350-3886
tofacitinib@bayshore.ca
Taro
TaroCares Patient Support Program
Taro-Tofacitinib
T: 1-833-437-0277
F: 1-833-544-0155
TaroCares@sdmshn.ca
