Alternatives to Xeljanz XR If You Can't Fill Your Prescription

Xeljanz XR (tofacitinib extended-release) is one of several oral and injectable medications available for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis. If you're temporarily unable to access it — due to prior authorization delays, coverage changes, or cost barriers — there are meaningful alternatives worth discussing with your doctor.

Important: Never stop a medication like Xeljanz XR without talking to your prescriber first. Abruptly discontinuing a JAK inhibitor can lead to disease flares. This guide is meant to help you have an informed conversation — not to replace medical advice.

Other JAK Inhibitors: The Closest Alternatives to Xeljanz XR

JAK inhibitors work the same way as tofacitinib — by blocking Janus kinase enzymes to reduce inflammation. Two others are FDA-approved in the U.S.:

Upadacitinib (Rinvoq)

Upadacitinib (brand name Rinvoq, made by AbbVie) is a selective JAK1 inhibitor taken once daily. It is FDA-approved for:

Rheumatoid arthritis (RA)

Psoriatic arthritis (PsA)

Ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis

Ulcerative colitis (UC) and Crohn's disease

Atopic dermatitis

Rinvoq carries similar boxed warnings to Xeljanz XR (serious infections, malignancy, thrombosis, mortality). Like Xeljanz XR, it requires prior authorization and is a specialty medication. It also shares the same class of safety concerns, so switching may not bypass all access hurdles. However, some patients find their insurer covers one JAK inhibitor better than another.

Baricitinib (Olumiant)

Baricitinib (Olumiant, made by Eli Lilly) is a once-daily JAK1/JAK2 inhibitor approved for moderate-to-severe RA in adults who have responded inadequately to one or more TNF inhibitors. It is also approved for alopecia areata (hair loss) and has been used for severe COVID-19 in hospitalized patients.

Baricitinib is not approved for UC, PsA, or AS, so it would only be an option if you have RA. It also carries the same class-level boxed warnings. Some patients with RA find baricitinib is more readily covered by certain insurance plans.

TNF Blockers: The Standard Biologic Alternative

TNF (tumor necrosis factor) inhibitors were the standard of care before JAK inhibitors became available, and they remain widely used. Common TNF blockers include:

Adalimumab (Humira) — Many biosimilars available (Hadlima, Hyrimoz, Cyltezo, etc.); lower cost options

Etanercept (Enbrel) — Self-injected weekly; widely covered for RA, PsA, AS

Certolizumab pegol (Cimzia) — Also used in RA, PsA, AS, and Crohn's disease

Infliximab (Remicade) — IV infusion every 6–8 weeks for RA, UC, and others; multiple biosimilars available

TNF blockers are injectables (or infusions), which is a significant difference for patients who value the oral convenience of Xeljanz XR. However, many insurance plans actually require failure of a TNF blocker before they'll cover a JAK inhibitor — so these may be the path your insurance requires anyway.

Other Biologic Options by Condition

Depending on your specific condition, your doctor may consider:

For RA: Abatacept (Orencia), tocilizumab (Actemra), sarilumab (Kevzara)

For UC: Vedolizumab (Entyvio), ozanimod (Zeposia), etrasimod (Velsipity), ustekinumab (Stelara)

For PsA/AS: Secukinumab (Cosentyx), ixekizumab (Taltz), guselkumab (Tremfya)

What About Generic Tofacitinib?

Generic tofacitinib (immediate-release) has been available since June 2021. Taking 5 mg twice daily delivers the same active ingredient as Xeljanz XR 11 mg once daily. If your access problem is cost-related, switching to the generic formulation may solve it without changing your treatment. The FDA also approved a generic Xeljanz XR (extended-release) from Ajanta Pharma in August 2025, though availability at retail pharmacies is still limited.

Talk to Your Doctor Before Switching

Every alternative medication comes with its own coverage requirements, side effect profile, and administration method. Before switching, talk openly with your rheumatologist or gastroenterologist about what's creating the access barrier. If insurance is the issue, read our guide on why Xeljanz XR is hard to find for strategies to resolve it directly.

If locating Xeljanz XR near you is the problem, medfinder can call pharmacies in your area to find which ones have it in stock and can fill your prescription today.