The polycythemia vera treatment market is at a turning point as older therapies near patent expiry and new biologics enter the scene. JAKAFI (ruxolitinib) has been the standard of care for patients who are resistant or intolerant to hydroxyurea, but its anticipated generic competition may face delays. This postponement prolongs JAKAFI’s market dominance and keeps treatment costs high for patients and payers.

The ongoing question of why is JAKAFI so expensive remains relevant. Annual treatment costs can exceed USD 100,000 depending on dosage and insurance coverage, creating financial challenges for patients and healthcare systems. While assistance programs provide some relief, long-term affordability remains a concern, especially if generic options are delayed.

Competition is increasing with Besremi (ropeginterferon alfa-2b). Its inclusion in the NCCN guidelines has strengthened physician confidence and adoption. Besremi is a long-acting interferon with disease-modifying potential, addressing the underlying clonal proliferation of abnormal blood cells rather than just controlling symptoms.

Besremi’s pricing is generally more cost-efficient than JAKAFI for long-term therapy, though it varies by region. Patients and providers frequently discuss besremi side effects, including flu-like symptoms, fatigue, and transient liver enzyme elevations. Most side effects are manageable, allowing patients to continue therapy over time. Its biweekly dosing schedule also supports better adherence.

Rusfertide, an injectable hepcidin mimetic developed by Protagonist Therapeutics, represents another innovative therapy. Designed to reduce the need for phlebotomy, rusfertide could improve quality of life while maintaining hematocrit control. Although rusfertide FDA approval is still pending, early clinical data are encouraging, showing meaningful effects in disease management.

Regulatory hurdles, such as the early withdrawal of Breakthrough Therapy Designation, slowed development but did not diminish interest. Rusfertide’s novel mechanism may influence the polycythemia vera interferon therapeutics market, offering an alternative to both JAK inhibitors and interferons once approved.

In summary, 2025 marks a transitional year for polycythemia vera treatment. JAKAFI (ruxolitinib) remains a dominant therapy, while Besremi (ropeginterferon alfa-2b) and rusfertide provide growing options for patients and clinicians. Long-term access and affordability will remain central concerns, and treatment decisions will depend on a combination of efficacy, safety, and cost.

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