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IncyteCARES for Jakafi is a program for residents of the United States and Puerto Rico.
Home Healthcare Professionals IncyteCARES for Jakafi Home Practice Resources
Healthcare Professionals
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.
The following codes are from the International Classification of Diseases, 10th Revision (ICD-10), which have been in effect since October 1, 2015.
Disease State
Jakafi ICD-10 Code
Myelofibrosis
Polycythemia Vera
Acute Graft-Versus-Host Disease (GVHD)
Chronic GVHD
Acute or Chronic GVHD
GVHD, Unspecified
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.
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.
Please see Full Prescribing Information for Jakafi.
Patient Terms and Conditions. Update effective as of March 1, 2023. You must have minimum out-of-pocket costs of $.01 to redeem this card. A monthly and yearly maximum benefit applies. Limit one 30-day supply per 30 days. Patients will be responsible for any out-of-pocket costs above the maximum annual and monthly program benefit. Card with member program number is valid through December 31 of the year of issue. 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. This card is not insurance. Offer valid only for an FDA-approved or compendia-recognized use. You are responsible for reporting receipt of program benefits to any commercial 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® (ruxolitinib) provided under this program as true out-of-pocket (TrOOP) spending 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. If you have any questions, please call 1-855-452-5234.
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