XELSOURCE 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 mail or fax to help patients apply for free medication.
Complete, print, and fax to register for xelsourceportal.com.
Examples when requesting coverage from patients’ insurance providers.
JAK=Janus kinase.