Comprehensive medication guide to Xeljanz XR including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0/month for commercially insured patients enrolled in Pfizer's Co-Pay Savings Program (up to $15,000/year); otherwise Tier 4–5 specialty copay ranging from $50–$200+/month depending on the plan. Medicare Part D patients capped at $2,000 out-of-pocket annually (2025 IRA).
Estimated Cash Pricing
$8,712 retail for brand-name Xeljanz XR 11 mg (30-day supply); as low as $3,200 with a GoodRx coupon at select pharmacies. Generic tofacitinib IR (5 mg twice daily) is significantly less expensive.
Medfinder Findability Score
72/100
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Xeljanz XR is the extended-release formulation of tofacitinib, an oral Janus kinase (JAK) inhibitor manufactured by Pfizer. The "XR" formulation allows once-daily dosing, offering the same therapeutic effect as the twice-daily immediate-release Xeljanz tablet with greater convenience. It was first approved by the FDA for rheumatoid arthritis in February 2016.
Xeljanz XR is FDA-approved for adults with moderately to severely active rheumatoid arthritis (RA), active psoriatic arthritis (PsA), active ankylosing spondylitis (AS), and moderately to severely active ulcerative colitis (UC) — in each case after inadequate response or intolerance to prior biologic or DMARD therapy.
As of June 2021, generic tofacitinib in the immediate-release formulation has been available in the U.S. A generic extended-release version (equivalent to Xeljanz XR) was FDA-approved from Ajanta Pharma in August 2025, though retail availability is still expanding.
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Tofacitinib is a small molecule JAK inhibitor that works inside cells by blocking Janus kinase enzymes — primarily JAK1 and JAK3. These enzymes are critical switches in the JAK-STAT signaling pathway, which immune cells use to receive and respond to pro-inflammatory cytokine signals (including IL-2, IL-6, IL-15, and interferons).
In autoimmune conditions like RA and UC, this pathway is overactivated — the immune system attacks the body's own tissues. By blocking JAK1/JAK3, tofacitinib interrupts the cytokine cascade that drives inflammation, reducing joint damage, pain, and gut inflammation.
Unlike biologic drugs (which are large proteins injected under the skin or into a vein), tofacitinib is a small molecule that is absorbed through the gut after swallowing. The XR extended-release formulation slowly dissolves over 24 hours, delivering a steady level of drug throughout the day.
11 mg — Extended-release tablet
Standard once-daily dose for RA, PsA, AS, and UC maintenance
22 mg — Extended-release tablet
Used for UC induction (first 8 weeks) only; NOT recommended for RA, PsA, or AS
Xeljanz XR is not on the FDA's drug shortage list as of 2026. Pfizer has maintained consistent manufacturing supply. However, as a specialty medication, it is not routinely stocked at most standard retail pharmacies. Most insurance plans require it to be dispensed through a designated specialty pharmacy such as CVS Specialty, Walgreens Specialty, Optum, or Accredo.
The main barriers to access are: prior authorization requirements (which take 5–10 business days on average), step therapy policies requiring prior failure of TNF blockers, and high retail costs. The medication is widely available through the specialty pharmacy system, but navigating insurance requirements can create significant delays.
If your plan allows retail pharmacy dispensing, or if you're paying cash, medfinder can call pharmacies near you to find which ones have Xeljanz XR in stock and can fill your prescription. Results are delivered by text so you don't have to make multiple phone calls yourself.
Xeljanz XR is not a controlled substance and can be prescribed by any licensed physician (MD/DO), nurse practitioner (NP), or physician assistant (PA) with prescribing authority. However, many insurance plans require initial prescribing by a relevant specialist to authorize the medication.
Rheumatologists — Primary prescribers for RA, PsA, and AS
Gastroenterologists — Primary prescribers for ulcerative colitis
Pediatric Rheumatologists — For pcJIA (tablets only, not XR)
Internal Medicine / Primary Care Physicians — May manage maintenance therapy for established patients
Nurse Practitioners and Physician Assistants — Can prescribe in most states; check plan-specific requirements
Telehealth is available for ongoing Xeljanz XR management with established patients. Initial workup, physical examination, and baseline labs typically require in-person visits. Platforms offering rheumatology or GI telehealth can support maintenance prescribing for stable patients.
No. Xeljanz XR (tofacitinib) is not a controlled substance. It is not scheduled by the DEA and does not have abuse potential. Any licensed prescriber with a valid DEA registration can prescribe Xeljanz XR without Schedule-specific restrictions.
However, prescriptions are typically initiated by specialists (rheumatologists for RA/PsA/AS, gastroenterologists for UC), and nearly all insurance plans require prior authorization. Prescriptions can be written for 30 or 90-day supplies and can be sent electronically to a specialty pharmacy.
The most common side effects reported with Xeljanz XR include:
Upper respiratory tract infections (colds, sinus infections)
Headache
Diarrhea and nausea
Elevated cholesterol (LDL and HDL both rise)
High blood pressure
Herpes zoster (shingles) — more common than in the general population
Serious infections (TB, fungal infections, viral infections) leading to hospitalization or death
All-cause mortality (higher vs. TNF blockers in RA patients 50+ with cardiovascular risk factors)
Malignancy (lymphoma, lung cancer, and others at higher rates vs. TNF blockers in RA)
Thrombosis (blood clots including pulmonary embolism and DVT)
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Upadacitinib (Rinvoq)
Selective JAK1 inhibitor; once daily; approved for RA, PsA, AS, UC, Crohn's, and atopic dermatitis
Baricitinib (Olumiant)
JAK1/JAK2 inhibitor; once daily; approved for moderate-to-severe RA and alopecia areata
Adalimumab (Humira / biosimilars)
TNF blocker biologic; injectable; widely used for RA, PsA, AS, UC; multiple biosimilars available at lower cost
Etanercept (Enbrel)
TNF blocker biologic; self-injected weekly; approved for RA, PsA, AS
Generic tofacitinib (IR)
Same active ingredient; 5 mg twice daily instead of 11 mg once daily; available since June 2021; significantly lower cost
Prefer Xeljanz XR? We can find it.
Strong CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin)
majorIncrease tofacitinib blood levels; dose reduction of Xeljanz XR to 5 mg once daily required
Strong CYP3A4 inducers (rifampin)
majorDramatically reduce tofacitinib blood levels, potentially causing treatment failure; avoid combination
Biologic DMARDs (adalimumab, etanercept, abatacept, tocilizumab)
majorContraindicated combination; additive immunosuppression with high infection risk
Other JAK inhibitors (upadacitinib, baricitinib)
majorContraindicated; additive immunosuppression
Potent immunosuppressants (azathioprine, cyclosporine, tacrolimus)
majorAdditive immunosuppression; combination not recommended
Fluconazole (moderate CYP3A4 + strong CYP2C19 inhibitor)
moderateIncreases tofacitinib exposure; dose reduction required
Live vaccines
majorDo not administer live vaccines during Xeljanz XR therapy; risk of vaccine-strain infection
St. John's Wort
moderateCYP3A4 inducer; reduces tofacitinib levels; avoid
Xeljanz XR (tofacitinib extended-release) is a proven, once-daily oral treatment for several serious autoimmune and inflammatory conditions. It offers the convenience of a pill over injectables or infusions, and for many patients it provides significant improvement in symptoms and quality of life after other treatments have failed.
The main challenges in 2026 remain access-related rather than supply-related: prior authorization, step therapy, specialty pharmacy routing, and high retail cost. These barriers can be navigated with help from your prescriber, Pfizer's XELSOURCE program (1-844-935-5269), and savings programs that can reduce monthly costs substantially.
If you're struggling to find a pharmacy that stocks Xeljanz XR and can fill your prescription, medfinder calls pharmacies in your area on your behalf and texts you the results. No hold music. No wasted calls.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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