Medicare Part D Ruxolitinib Spending Hits $49.6 Million as Use Surges

Medicare Part D prescribing of topical ruxolitinib (Opzelura; Incyte) climbed from just 5 clinicians nationwide in 2021 to more than 1000 by 2024, causing annual program spending to increase from roughly $256,000 to $49.6 million, according to a cross-sectional study published in JAAD International.¹ Among dermatologists in 2024, the drug's cost per day of therapy (CPD) was more than 16 times higher than generic tacrolimus.

Topical ruxolitinib 1.5% cream is the first FDA-approved topical Janus kinase (JAK) inhibitor, cleared for atopic dermatitis (AD) in September 2021 and for nonsegmental vitiligo in July 2022.^2,3 Researchers from Columbia University Irving Medical Center analyzed the CMS Medicare Part D Prescribers by Provider and Drug Public Use File from 2018 to 2024, comparing ruxolitinib against 3 established nonsteroidal topical anti-inflammatories used for AD: crisaborole (Eucrisa; Pfizer), generic tacrolimus ointment, and generic pimecrolimus cream.

Among dermatologists specifically, ruxolitinib prescribers grew from 2 in 2021 to 580 in 2024, with claims growing from 42 to 13,028 over the same period. Crisaborole prescribing among dermatologists, by contrast, peaked in 2019 at 78 prescribers and 2079 claims before declining to 40 prescribers and 695 claims by 2024. Generic tacrolimus claims among dermatologists more than quadrupled, from 32,394 in 2018 to 141,342 in 2024, while generic pimecrolimus claims roughly doubled, from 7772 to 15,671.

Cost Per Day and Specialty Distribution Diverge Sharply

By 2024, dermatologists' CPD for topical ruxolitinib reached $68.76 compared with $27.97 for crisaborole, $7.69 for generic pimecrolimus, and $4.29 for generic tacrolimus—a 16.0-fold gap vs tacrolimus and an 8.9-fold gap vs pimecrolimus. The authors noted that at 2024 prices, a single year of dermatologists’ ruxolitinib spending would purchase roughly 17,500 patient-years of generic tacrolimus, although they cautioned the drugs are not direct clinical substitutes.

In pooled phase 3 trials, ruxolitinib achieved Investigator's Global Assessment success in about half of patients with AD, while tacrolimus 0.1% ointment produced near-clearance in about 37% of adults, with application-site burning often limiting its tolerability. “These differences may justify a price premium for selected patients,” the authors suggested.

Ruxolitinib prescribing was heavily concentrated in dermatology and dermatology-affiliated advanced practice settings: dermatologists wrote 54.9% of 2024 claims, physician assistants 26.4%, nurse practitioners 12.0%, primary care physicians 2.9%, and allergy/immunology specialists 1.3%. Crisaborole's prescriber base was far more evenly distributed, with primary care physicians alone accounting for 17.7% of its claims.

The authors speculated that the drug's recency, its indications, prior authorization requirements, and its boxed warning for JAK inhibitors could each plausibly explain the concentration, although the data could not isolate which factor mattered most. Geographic concentration was pronounced as well: New York and California together accounted for 56.0% of national ruxolitinib claims in 2024, and only Idaho recorded no Part D prescribing of the drug that year.

Specialty Drug Spending in Broader Context

A separate analysis from 2025 of Part D claims found that specialty medications, whose spending grew 29.3% annually, drove the bulk of a 16.1% annual increase in total dermatology drug spending from 2013 to 2022, with newer therapies responsible for nearly 70% of that growth.⁴ In addition, panelists at a recent roundtable on vitiligo care from The American Journal of Managed Care® similarly described ruxolitinib as having become the default first-line agent for that condition despite payers routinely resisting coverage, with one expert estimating a year's supply at roughly $6000.⁵ Nanette Silverberg, MD, MPHc, chief of pediatric dermatology at Mount Sinai, argued that the high cost offsets the downstream expenses of undertreating vitiligo.

“If you don't effectively institute topical therapy to start with, you have patients who stay within the system under treatment forever,” she said.

The study authors noted CMS suppresses prescriber-drug-year combinations with 10 or fewer claims and that the public-use file lacks diagnosis codes, so they could not separate ruxolitinib prescriptions written for AD from those for vitiligo or off-label uses.¹

“Continued surveillance will be important as additional topical Janus kinase inhibitors enter the market and pediatric indications evolve,” they wrote.

References

1. Kent JA, Malave GS, Sacknovitz Y, Geskin LJ. Utilization, cost, and specialty distribution of topical ruxolitinib prescribing in Medicare Part D, 2018-2024: a cross-sectional study. JAAD Int. 2026;28:121-123. doi:10.1016/j.jdin.2026.08.003
2. AJMC Staff. Ruxolitinib cream approved for short-term treatment of atopic dermatitis. AJMC^®. September 22, 2021. Accessed September 24, 2026. https://www.ajmc.com/view/ruxolitinib-cream-approved-for-short-term-treatment-of-atopic-dermatitis
3. Gavidia M. FDA approves ruxolitinib cream as first repigmentation therapy for vitiligo. AJMC. July 19, 2022. Accessed September 24, 2026. https://www.ajmc.com/view/fda-approves-ruxolitinib-cream-as-first-repigmentation-therapy-for-vitiligo
4. Santoro C. Specialty drug costs drive Medicare Part D dermatology expenditures. AJMC. July 22, 2025. Accessed September 24, 2026. https://www.ajmc.com/view/specialty-drug-costs-drive-medicare-part-d-dermatology-expenditures
5. Jeremias S. Experts weigh vitiligo's cosmetic label as oral therapies near. AJMC. August 17, 2026. Accessed September 24, 2026. https://www.ajmc.com/view/experts-weigh-vitiligo-s-cosmetic-label-as-oral-therapies-near