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IncyteCARES is a program for residents of the United States and Puerto Rico.
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.
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.
The following codes are from the International Classification of Diseases, 10th Revision (ICD-10), which have been in effect since October 1, 2015.
Incyte has provided these codes as background information. They are some of the available ICD-10-CM codes that relate to these disease states. They are not intended to encourage or address the use of any specific ICD-10-CM codes for individual patients. Using the codes provided does not guarantee or support payment, coverage, or reimbursement decisions.
For more information about ICD-10 codes, visit CMS.gov.
Printable IncyteCARES Enrollment Form With Patient Authorization
Download and complete this form to enroll patients in IncyteCARES. Includes instructions for submitting it by fax or mail.
Online Patient Authorization Form for IncyteCARES
For patients who have not signed the IncyteCARES enrollment form you completed, they can complete the last step for enrollment here.
Specialty Pharmacies List
Includes all US specialty pharmacies that dispense Incyte medications.
Letter of Medical Necessity
Some payers require documentation of medical necessity for certain medications before approving coverage. This sample letter, with fillable fields, can be used for this requirement.
Letter of Appeal
This sample letter, with fillable fields, can be used to appeal an insurer’s denial of coverage for an Incyte medication.
IncyteCARES FAQs for HCPs
Printable version of frequently asked questions is a convenient reference for you and your office staff.
Please see Full Prescribing Information for Jakafi.
Patient Terms and Conditions. Updated effective as of January 1, 2021. Amount of savings on Jakafi® (ruxolitinib) will not exceed $11,977 per month and $25,000 per year, limit one 30-day supply per 30 days. You must have minimum out-of-pocket costs of $.01 to redeem this. Patients will be responsible for any out-of-pocket costs above the maximum annual and monthly program benefit. Card must be activated before use. Card is valid through December 31 of the year of activation. On January 1 of the following year, the card automatically resets and is subject to annual limits if the prescription benefit remains the same. Offer is not valid if you are uninsured or paying cash for your prescription. Offer is not valid if you are enrolled in a federal or state prescription program (including Medicare Part D, Medicare Advantage, Medicaid, TRICARE, or any state medical or pharmaceutical assistance program). If you move or switch from commercial prescription benefit coverage to any government prescription benefit coverage, you will no longer be eligible. If you have any questions, please call 1-855-452-5234. This card is not insurance. Offer valid only for an FDA-approved or recognized compendia use. You are responsible for reporting receipt of program benefits to any commercial or private insurer that pays for or reimburses any part of the prescriptions filled with this program, to the extent required by law or by the insurer. You agree not to seek reimbursement from your insurer or any other third party for all or any part of the benefit received through this offer. This card may not be sold, purchased, traded, or transferred and is void if reproduced. You agree that you will not in any way report or count the value of the Jakafi provided under this program as true out-of-pocket spending (TrOOP) under a Medicare Part D prescription drug benefit. One card per patient. No substitutions are permitted. Use of this card does not obligate you to use or continue to use Jakafi. No other purchase and no refills are necessary. This offer is limited to one (1) per person during this offering period and is not transferable. You are responsible for all taxes. Program cards are the property of Incyte Corporation and must be turned in on request. No membership fees. Offer is good only in the United States and Puerto Rico, and void where prohibited or otherwise restricted by law. Residents of states prohibiting or restricting offers of this type are not eligible. Incyte Corporation reserves the right to rescind, revoke, or amend this program without notice.
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