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 indicated for treatment of steroid-refractory acute graft-versus-host disease (aGVHD) in adult and pediatric patients 12 years and older.
Jakafi is indicated for treatment of chronic graft-versus-host disease (cGVHD) after failure of one or two lines of systemic therapy in adult and pediatric patients 12 years and older.
ICD-10 Codes for Jakafi® (ruxolitinib)
The following codes are from the International Classification of Diseases, 10th Revision (ICD-10), which have been in effect since October 1, 2015.
Acute Graft-Versus-Host Disease (GVHD)
Acute or Chronic GVHD
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.
The healthcare provider is responsible for determining appropriate codes for billing. This information is not intended to be definitive or exhaustive, or to serve as a replacement for the guidance of a professional advisor.
For more information about ICD-10 codes, visit CMS.gov.
Forms, Documents, and More
IncyteCARES for Jakafi Enrollment Form With Patient Authorization (PDF)
Download and complete this form to enroll patients in IncyteCARES for Jakafi. Includes instructions for submitting it by fax or mail.
Online Patient Authorization Form for IncyteCARES for Jakafi
For patients who have not signed the IncyteCARES for Jakafi enrollment form you completed, they can complete the last step for enrollment online at the link above.
Specialty Pharmacies List (PDF)
Includes all US specialty pharmacies that dispense Incyte medications.
Letter of Medical Necessity (PDF)
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 (PDF)
This sample letter, with fillable fields, can be used to appeal an insurer’s denial of coverage for an Incyte medication.
IncyteCARES for Jakafi FAQs for HCPs (PDF)
Printable version of frequently asked questions is a convenient reference for you and your office staff.