XELSOURCESM Forms and Resources

DOWNLOAD THESE XELSOURCE PDFs FOR PATIENTS WHO HAVE BEEN PRESCRIBED XELJANZ AND ARE INTERESTED IN ENROLLING IN XELSOURCE

Complete, print, and fax to enroll patients in XELSOURCE.

Complete, print, and
fax to register for xelsourceportal.com.

Complete, print, and mail or fax to help patients apply for free medication.

Examples when requesting coverage from patients’ insurance providers.