RxAssist Home
RxAssist Home Home  |  About Us  |  Contact RxAssist          
      Patient Assistance Program Center
 
 

Program Details

INCYTE CORPORATION
IncyteCARES Patient Assistance Program - Jakafi

Jakafi Tablet (ruxolitinib)
 
CONTACT INFO
Address: PO Box 221798
Charlotte, NC 28222-1798
Phone: 1-855-452-5234 Provider Phone:
Fax: 1-855-525-7207 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Patient must not have prescription coverage for needed medication or have exhausted or been denied coverage for Jakafi and meet household income criteria.
  • Patients enrolled in Medicare Part D may be eligible, contact program for details.
  • Medication must be used for an FDA-approved diagnosis.
  • Program also offers co-pay assistance for eligible patients.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    Proof of insurance, if applicable
    Physician License #
    Required:
    Both DEA and State
    NPI
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Both Provider and Patient
    MEDICATION
    Receives: Medication
    Shipped To: Either Provider and Patient
    Quantity in Shipment: Up to 90-day supply
    Delivery Time: Not Published
    Re-application Policy: New application every 12 months
    New financial information every 12 months
    Refill Policy: Contact the program for refills
    Other Information:

    Last Updated: 07/18/2024

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    DocumentForm (English)



     

    Print-friendly version

    This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. Neither RxAssist nor RxVantage is offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. Neither RxVantage nor RxAssist provide any warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment. Third party logos, trademarks, brand names and images contained on rxassist.org or rxvantage.com are for demonstration purposes only and are owned by their respective rights holders, who are not affiliated with this Site.

    Copyright © 2024, RxVantage, all rights reserved.