CareCost Medicare allows
$20.949
per unit · ASP+6%, Q4 2026
Original Medicare: the patient owes $1,270.37 for a 300 mg infusion
Medicare allows $6,351.84 for the drug and its administration. The patient owes 20% of it once the Part B deductible is met, and a Medigap plan can take that to $0.
Estimate for your patient ↓Pick the dose and schedule, choose the plan, and add a Medigap plan if there is one.
The dose is flat at 300 mg for every infusion — induction at weeks 0, 2 and 6, then maintenance every 8 weeks · there is no weight-based dosing
30-minute infusion: 96366 (each additional hour) does not apply.
Include only when a significant, separately identifiable E/M service is performed and documented (modifier 25).
| Item | Qty | Payer allows | Patient owes |
|---|---|---|---|
| Entyvio (vedolizumab) J3380 | 300 | $6,284.70 | $1,256.94 |
| Infusion administration, initial hour 96365 | 1 | $67.14 | $13.43 |
| Total | $6,351.84 | $1,270.37 |
Medicare's 80% payment is reduced by the 2% sequester; the patient's 20% coinsurance is not affected.
The estimate above assumes the deductible is already met. Most patients are part-way through theirs for most of the year, and that changes what they owe today.
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Original Medicare · Entyvio · 300 mg
Patient owes · deductible met
Commercial estimates use the payer’s published rate and this patient’s actual benefits.
$20.949 per mg is Part B's ASP+6% rate for Q4 2026. At the 300 mg dose the drug alone runs $6,284.70, and the patient's 20% coinsurance on the full claim (drug plus the 96365 administration line) is $1,270.37 once the $283 Part B deductible is met, with no annual out-of-pocket maximum to cap it. Full explanation: How Medicare Part B drug cost sharing works →
Medicare pays J3380 per 1 mg billing unit, not per vial or per dose. A 300 mg dose is 300 billing units, the whole single-dose vial, so JZ (no discarded drug) applies and JW never does. The MUE for J3380 is 300 units per day, matching the vial exactly, so there's no split-claim math on a full dose.
| Visit | Timing | Units | Medicare drug allowed |
|---|---|---|---|
| Induction 1 | Week 0 | 300 | $6,284.70 |
| Induction 2 | Week 2 | 300 | $6,284.70 |
| Induction 3 | Week 6 | 300 | $6,284.70 |
| Maintenance | Every 8 weeks after | 300 | $6,284.70 |
Entyvio doesn't titrate: every infusion, induction or maintenance, is the same single 300 mg vial, so the patient's 20% coinsurance is $1,270.37 on every claim once the deductible is met. What changes is how many infusions land in a calendar year. A maintenance year, priced at 7 doses, totals $44,462.88 before the sequester. The first year is not a maintenance year — it runs 8 infusions, at weeks 0, 2, 6, 14, 22, 30, 38 and 46, because the three induction visits are closer together than the every-8-week pattern that follows.
For the reference patient — 300 mg, 300 units, drug plus the 96365 administration code — Medicare allows $6,351.84, and the Part B coinsurance on that is $1,270.37. Plans A, B, C, D, F, G, M and N cover that coinsurance in full, so those patients owe nothing per infusion once the $283 deductible is met. Plans K and L do not, and because Entyvio's maintenance visits are 8 weeks apart, most claims in a plan year land after the deductible is already met. The infusion that lands before the deductible is met costs a Plan K patient $889.88; every infusion after it costs $635.18. See what each Medigap plan (A–N) owes on this claim →
| Plan | Covers Part B deductible ($283) | Covers Part B coinsurance | Patient owes, deductible met | Patient owes, deductible not met |
|---|---|---|---|---|
| Plan K | No | 50% | $635.18 | $889.88 |
| Plan L | No | 75% | $317.60 | $586.45 |
Only the letters that leave this patient a balance are listed. The full A–N grid, the high-deductible variants, Plan N’s office-visit carve-out and the MACRA restriction on Plans C and F are at Medigap Plans A–N.
Payers negotiate their own rate for J3380, not ASP+6%. Our corpus holds published rates from 37 of 37 payer files, and Aetna's all-states median is $21.72 per unit, putting the 300-unit dose at $6,516.00 before benefits. That rate differs by payer and state, and it is not what the patient actually pays either — their own plan benefits set that number. Full explanation: How commercial drug reimbursement works →
| Drug | HCPCS | ASP+6% per mg |
|---|---|---|
| Entyvio (vedolizumab) | J3380 | $20.949 |
| Remicade (infliximab) | J1745 | $2.986 |
| Stelara IV (ustekinumab) | J3358 | $10.249 |
| Skyrizi IV (risankizumab-rzaa) | J2327 | $14.011 |
| Simponi Aria (golimumab) | J1602 | $10.978 |
These four price under the same ASP+6% mechanism as Entyvio, but at a different rate per mg and a different labeled dose, so the per-mg number alone doesn't translate into a comparable per-infusion total. Step therapy in the coverage corpus most often requires a conventional therapy trial first, and many payers also require a TNF inhibitor such as infliximab or the plan's preferred infliximab biosimilar before Entyvio is approved. See which payers require what →
| Quarter | ASP+6% per mg |
|---|---|
| 2025 Q1 | $21.67 |
| 2025 Q2 | $21.16 |
| 2025 Q3 | $22.06 |
| 2025 Q4 | $21.31 |
| 2026 Q1 | $21.37 |
| 2026 Q2 | $20.98 |
| 2026 Q3 (current) | $21.62 |
On a commercial plan, the EntyvioConnect Co-pay Program can take the drug cost to $0 per dose, up to $20,000 a year, and it covers the drug line only; the 96365 administration is billed separately and isn't part of the program. It excludes Medicare, Medicaid, TRICARE, VA and other government program patients. We have no free-drug program on file for Entyvio.
The four foundation funds that cover inflammatory bowel disease in our records — HealthWell Inflammatory Bowel Disease ($2,100/year), TotalAssist Inflammatory Bowel Disease ($10,400/year), TotalAssist Ulcerative Colitis ($3,000/year) and HealthWell AutoImmune Medicare Access ($2,800/year) — were all closed as of September 7, 2026. HealthWell's ANCA-Associated Vasculitis fund is open, but it doesn't apply: vasculitis isn't an Entyvio indication. That leaves a Medigap plan as the only route to $0 on Medicare today. See every program for this patient, with current status →
A patient who switches to the subcutaneous 108 mg pen after the first two IV doses leaves this calculation entirely. The pen carries no HCPCS code and is priced through the pharmacy benefit, not billed by the infusing practice, so it never appears as a J3380 or 96365 claim line.
Original Medicare allows $6,351.84 for a 300 mg infusion plus the 96365 administration code, and the patient's 20% coinsurance is $1,270.37 once the Part B deductible is met. A Medigap plan can take that to $0. What each Medigap plan leaves on this claim ↓
$20.949 per mg for Q4 2026 (ASP+6%). At the 300 mg dose that's 300 billing units, so Medicare's allowed drug amount is $6,284.70.
No. EntyvioConnect covers the drug cost only, down to $0 per dose on a commercial plan, up to $20,000 a year; the 96365 administration charge is billed separately and isn't part of the program. See every program for this patient →
The single 300 mg vial is 300 billing units of J3380, or $6,284.70 at the Q4 2026 ASP+6% rate of $20.949 per mg. Every infusion, induction or maintenance, uses exactly one vial, so JZ applies every time and JW never does.
Nothing to bill under J3380. The 108 mg subcutaneous pen and syringe carry no HCPCS code and are priced through the pharmacy benefit instead, so once a patient moves from IV to the pen after the first two infusions, the practice stops billing J3380 and 96365 for that patient entirely.
Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (96365, 99214, national non-facility); Medicare Part B deductible (2026); Medicare Rights Center 2026 Medigap plan benefits chart; 37 commercial payer published price files (Q2 2026); EntyvioConnect Co-pay Program terms (entyvio.com/copay-support); HealthWell Foundation and TotalAssist fund status, verified Sep 7, 2026.
Reviewed September 21, 2026 by Erin Rose, CareCost Estimate founder. Methodology →