Renew Your Co-Pay Savings Card

If eligible, you can continue saving on XELJANZ by renewing your Co-Pay Savings Card with one simple step. Please complete the form below, so you can receive your new card.

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Are you currently taking:

PLEASE VERIFY THE FOLLOWING INFORMATION TO RECEIVE A CO-PAY SAVINGS CARD.

  • I do not have insurance from any federal healthcare program (including Medicare, Medicaid, TRICARE, or any other state or federal medical pharmaceutical benefit program or pharmaceutical assistance program).
  • I am not over 65 years of age and retired, and if applicable, neither is my partner.
  • I do not receive Social Security Disability or any other Social Security Administration benefit.
  • I do not receive health insurance through the military.
  • I agree with the limits, terms, and conditions that apply.

Only current, commercially insured XELJANZ or XELJANZ XR patients are eligible for the Co-Pay Savings Card. Whether you want to learn more about XELJANZ or have already started on treatment, we can provide you with tools, resources, and support.