Ruxolitinib (Jakafi®)

Self administration- Oral

Indications for Prior Authorization

  • indicated for the treatment of patients with intermediate or high risk myelofibrosis (MF): primary MF, post-polycythemia vera MF, and post essential thrombocythemia MF.

Patients must meet the following criteria for the indication(s) above.

Patients with active serious infections should not be treated until the infection resolves. A complete baseline blood count must be done prior to initiation of therapy and every two-four weeks until the dose is stabilized.

The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee.

  • All non-FDA approved uses not listed in the approved indications

Recommended Dosing

Patient dosing based on platelet count

platelet count

100-200 x 109/L

>200 x 109/L

starting dose 15 mg twice daily 20 mg twice daily

Dose may be increased in increments of 5 mg twice daily up to a maximum dose of 25 mg twice daily (50 mg per day) Dosing must be adjusted for both renal and hepatic impairment.

Ruxolitinib should be tapered on discontinuation. The recommendation is to reduce the dose by 5 mg twice daily each week.

Dose taper is not recommend if discontinuation is due to thrombocytopenia.


Six months

Treatment should be discontinued at 6 months if no spleen size reduction is seen

Western Health Advantage Pharmacy and Therapeutics Committee

Approved/Revised: March 2012 Reviewed: December 2013