Does Medicare Cover Jakafi?

Medicare Benefits Solutions
Mar 3, 2021

Jakafi is a prescription medication that doctors offer to help patients manage certain bone marrow conditions. One significant condition where this medication would be appropriate is if someone has polycythemia vera. The drug’s main use is to stop your body from creating things known as growth factors. Growth factors are protein molecules that stimulate your cells to divide and grow. They can also cause severe spleen and blood cell issues. Does Medicare insurance cover the cost of Jakafi?

What Jakafi Does

It’s important to know that this prescription isn’t a cure for your bone marrow disorder. However, it can help reduce the symptoms you experience and improve your quality of life. It can help with premature satiety, pain under the left ribs, abdominal pain or discomfort, itchiness, night sweats, muscle pain, or bone pain. This is the only and first medication that the U.S. Food and Drug Administration approved to help treat bone marrow disorder patients.

Jakafi and Medicare Coverage

If your Medicare coverage includes this prescription, it’ll be under Medicare Part D. You’ll have to check your plan’s specific formulary. This is the plan’s list of drugs it will cover. You should look for Jakafi specifically. This drug also comes under the generic name of ruxolitinib, so make sure you look for this if you don’t find Jakafi. 

Depending on the plan you choose, your drug coverage and prices will vary. For people who have Original Medicare insurance, you’re able to enroll in a stand-alone Prescription Drug Plan. You can also choose to go with a Medicare Advantage plan. These plans offer the same levels of coverage you get under Original Medicare, but they also usually offer more coverage options. This often includes coverage for your prescriptions. You want to enroll in Part D’s prescription drug coverage when the initial eligibility period opens to avoid late penalties. 

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Jakafi Side Effects

There are several potential side effects you may experience from taking Jakafi. However, they’ll vary from person to person. Some people may not experience anything, or they may be very mild. Other people could experience more severe side effects. You want to monitor them and report them to your doctor. You could experience headaches, dizziness, or bruising. 

Jakafi Costs

This is an expensive medication, so you will want to make sure that you have Medicare coverage for it. Without any coverage, you can expect to pay $14,821 for a supply of 60 five-milligram tablets. This cost will fluctuate depending on your pharmacy. 

If you have Medicare insurance, you may be responsible for coinsurance and copayment. The Part D deductible of $445 for 2021 also applies to the cost. Generally speaking, you can expect to pay between $53 to $248 each time you pick up your prescription of Jakafi. If you have a Medicare Advantage plan, it’s a good idea to call your insurance provider because each plan’s costs and coverage can vary.

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