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IncyteCARES is a program for residents of the United States and Puerto Rico.

How to Enroll Patients in
IncyteCARES for Jakafi

IncyteCARES: A Patient Assistance and Support Program IncyteCARES: A Patient Assistance and Support Program IncyteCARES: A Patient Assistance and Support Program

Enroll your eligible patients now.

They may qualify for the Copay/Coinsurance Program or other assistance options.*

*Terms and conditions apply. Terms of this program may change at any time.

ACCESS AN IncyteCARES ENROLLMENT FORM. COMPLETION TAKES ABOUT 15 MINUTES

A completed IncyteCARES Program Enrollment Form can also serve as your patient's first prescription.

TO SUBMIT VIA FAX

Your Incyte representative can also provide a tearpad of IncyteCARES enrollment forms.

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TO SUBMIT VIA OUR SECURE WEBSITE

There’s no need to set up an account or password.
For security, information you enter in the online form is not saved when you close it.

Note that not all patients who have been prescribed Jakafi® (ruxolitinib) are eligible to enroll in IncyteCARES for Jakafi or to receive all services we provide. Contact IncyteCARES at 1-855-452-5234 for more information.

FOLLOW THESE SIMPLE STEPS

Save time by gathering required patient information before you start!

STEP 1: Complete the Patient Information (or have your patient complete it) including:

  • Patient shipping address for medication delivery
  • Contact phone number(s)
  • Prescription insurance information
  • Financial information (if being considered for Patient Assistance Program)

STEP 2: Complete the Physician Information including:

  • Practice and provider information
  • Patient’s clinical information
  • Patient’s prescription details

STEP 3: Review and sign the Physician Declaration (You can e-sign the online enrollment form)

STEP 4: Submit the IncyteCARES Program Enrollment Form with or without the signed Patient Authorization

You can have your patient sign the Patient Authorization section of the enrollment form before you submit it. Or you can leave it blank and IncyteCARES will call your patient to get verbal authorization for the program. (Patient authorization is not needed if you’re requesting only a benefits verification.)

ONCE AN ELIGIBLE PATIENT IS ENROLLED, AN IncyteCARES REPRESENTATIVE WILL CALL TO:

  • Review coverage and costs for the prescribed medication
  • Coordinate the patient’s prescription and monthly delivery with an appropriate specialty pharmacy
  • Offer financial assistance options for which the patient may be eligible
  • Explain other resources and support available to the patient during treatment

DID YOU KNOW?

Sometimes, patients contact IncyteCARES directly to start an enrollment form. In that case, an IncyteCARES representative will take the patient’s information and may call the prescriber’s office to gather the additional information needed to qualify and enroll the patient.

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CONTACT IncyteCARES

Our team is available Monday through Friday, 8 am–8 pm ET

Call us at 1-855-452-5234

INDICATIONS AND USAGE

Jakafi is indicated for treatment of polycythemia vera (PV) in adults who have had an inadequate response to or are intolerant of hydroxyurea.

Jakafi is indicated for treatment of intermediate or high-risk myelofibrosis (MF), including primary MF, post–polycythemia vera MF and post–essential thrombocythemia MF in adults.

Jakafi is also indicated for treatment of steroid-refractory acute graft-versus-host disease (GVHD) in adult and pediatric patients 12 years and older.

IMPORTANT SAFETY INFORMATION

  • Treatment with Jakafi® (ruxolitinib) can cause thrombocytopenia, anemia and neutropenia, which are each dose‐related effects. Perform a pre‐treatment complete blood count (CBC) and monitor CBCs every 2 to 4 weeks until doses are stabilized, and then as clinically indicated
  • Manage thrombocytopenia by reducing the dose or temporarily interrupting Jakafi. Platelet transfusions may be necessary
  • Patients developing anemia may require blood transfusions and/or dose modifications of Jakafi
  • Severe neutropenia (ANC <0.5 x 109/L) was generally reversible by withholding Jakafi until recovery
  • Serious bacterial, mycobacterial, fungal and viral infections have occurred. Delay starting Jakafi until active serious infections have resolved. Observe patients receiving Jakafi for signs and symptoms of infection and manage promptly. Use active surveillance and prophylactic antibiotics according to clinical guidelines.
  • Tuberculosis (TB) infection has been reported. Observe patients taking Jakafi for signs and symptoms of active TB and manage promptly. Prior to initiating Jakafi, evaluate patients for TB risk factors and test those at higher risk for latent infection. Consult a physician with expertise in the treatment of TB before starting Jakafi in patients with evidence of active or latent TB. Continuation of Jakafi during treatment of active TB should be based on the overall risk-benefit determination
  • Progressive multifocal leukoencephalopathy (PML) has occurred with Jakafi treatment. If PML is suspected, stop Jakafi and evaluate
  • Advise patients about early signs and symptoms of herpes zoster and to seek early treatment
  • Increases in hepatitis B viral load with or without associated elevations in alanine aminotransferase and aspartate aminotransferase have been reported in patients with chronic hepatitis B virus (HBV) infections. Monitor and treat patients with chronic HBV infection according to clinical guidelines
  • When discontinuing Jakafi, myeloproliferative neoplasm-related symptoms may return within one week. After discontinuation, some patients with myelofibrosis have experienced fever, respiratory distress, hypotension, DIC, or multi-organ failure. If any of these occur after discontinuation or while tapering Jakafi, evaluate and treat any intercurrent illness and consider restarting or increasing the dose of Jakafi. Instruct patients not to interrupt or discontinue Jakafi without consulting their physician. When discontinuing or interrupting Jakafi for reasons other than thrombocytopenia or neutropenia, consider gradual tapering rather than abrupt discontinuation
  • Non-melanoma skin cancers including basal cell, squamous cell, and Merkel cell carcinoma have occurred. Perform periodic skin examinations
  • Treatment with Jakafi has been associated with increases in total cholesterol, low-density lipoprotein cholesterol, and triglycerides. Assess lipid parameters 8-12 weeks after initiating Jakafi. Monitor and treat according to clinical guidelines for the management of hyperlipidemia
  • In myelofibrosis and polycythemia vera, the most common nonhematologic adverse reactions (incidence ≥15%) were bruising, dizziness, headache, and diarrhea. In acute graft-versus-host disease, the most common nonhematologic adverse reactions (incidence >50%) were infections and edema
  • Dose modifications may be required when administering Jakafi with strong CYP3A4 inhibitors or fluconazole or in patients with renal or hepatic impairment. Patients should be closely monitored and the dose titrated based on safety and efficacy
  • Use of Jakafi during pregnancy is not recommended and should only be used if the potential benefit justifies the potential risk to the fetus. Women taking Jakafi should not breastfeed during treatment and for 2 weeks after the final dose