CareCost Medicare allows
$4.185
per unit · ASP+6%, Q4 2026
Original Medicare: the patient owes $599.33 for a 1,400 mg infusion
Medicare allows $2,996.64 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.
Dosing climbs 350 mg → 700 mg → 1,050 mg over the first three infusions, then holds at 1,400 mg every 4 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 |
|---|---|---|---|
| Kisunla (donanemab-azbt) J0175 | 700 | $2,929.50 | $585.90 |
| Infusion administration, initial hour 96365 | 1 | $67.14 | $13.43 |
| Total | $2,996.64 | $599.33 |
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 · Kisunla · 1,400 mg
Patient owes · deductible met
Commercial estimates use the payer’s published rate and this patient’s actual benefits.
$4.185 per 2 mg ($2.0925/mg) is Part B's ASP+6% rate for Q4 2026. At the 1,400 mg maintenance dose the drug alone runs $2,929.50, and the patient's 20% coinsurance on the full claim is $599.33 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 J0175 per 2 mg billing unit, not per vial or per dose. A 1,400 mg dose is 700 billing units — divide the ordered mg by 2, not by the 350 mg vial size.
| Infusion | Dose | Units | Medicare drug allowed |
|---|---|---|---|
| Infusion 1 | 350 mg | 175 | $732.38 |
| Infusion 2 | 700 mg | 350 | $1,464.75 |
| Infusion 3 | 1,050 mg | 525 | $2,197.13 |
| Infusion 4 and beyond | 1,400 mg | 700 | $2,929.50 |
Dosing climbs 350 mg → 700 mg → 1,050 mg before settling at 1,400 mg every 4 weeks — about 13 infusions a year at that maintenance dose. Every step is a whole multiple of the 350 mg vial, so JZ applies on all four infusions and JW never does.
The 20% coinsurance climbs with the dose: infusion 1's drug coinsurance is 20% of $732.38, or $146.48, plus the $13.43 infusion line, for $159.91 once the deductible is met. Infusion 2's drug coinsurance is $292.95; infusion 3's is $439.43; from infusion 4 on, the maintenance dose puts it at $585.90 — each with the same $13.43 infusion line added.
For the reference patient — 1,400 mg, 700 units, drug plus the 96365 administration code — Medicare allows $2,996.64, and the Part B coinsurance on that is $599.33. 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 Kisunla is billed every 4 weeks, 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 $554.36; every infusion after it costs $299.66. 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% | $299.66 | $554.36 |
| Plan L | No | 75% | $149.84 | $418.69 |
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.
Commercial payers negotiate their own rate for J0175, not ASP+6%. Our corpus holds published rates from 36 of 36 payer files, and Aetna's all-states median is $4.19 per unit (2 mg), putting the 700-unit maintenance dose at $2,933.00 before benefits. Rates vary by payer and state, and what the patient owes then depends on their specific benefits. Full explanation: How commercial drug reimbursement works →
| Drug | HCPCS | ASP+6% | Maintenance dose | Drug allowed |
|---|---|---|---|---|
| Kisunla (donanemab-azbt) | J0175 | $4.185 per 2 mg | 1,400 mg every 4 weeks | $2,929.50 |
| Leqembi (lecanemab-irmb) | J0174 | $1.361 per mg | 10 mg/kg every 2 weeks | Varies by weight |
Both bill 96365 alone for a roughly 30-minute infusion, never 96413. Kisunla titrates to a flat 1,400 mg maintenance dose given every 4 weeks; Leqembi is dosed by weight every 2 weeks, so its per-claim drug cost depends on the patient rather than a fixed number. The two are not interchangeable, and a payer may require one before the other — 3 of 20 Kisunla policies in our corpus require Leqembi first.
| Quarter | ASP+6% per 2 mg |
|---|---|
| 2025 Q1 | $4.09 |
| 2025 Q2 | $4.18 |
| 2025 Q3 | $4.14 |
| 2025 Q4 | $4.13 |
| 2026 Q1 | $4.17 |
| 2026 Q2 | $4.14 |
| 2026 Q3 | $4.17 |
| 2026 Q4 (current) | $4.19 |
On a commercial plan, the Kisunla Savings Card Program can take the drug copay to $0 per infusion (up to $9,450 a year), and the card covers the drug line only; the 96365 administration is billed separately. It excludes Medicare, Medicaid and other government program patients. Uninsured patients may qualify for free drug through Lilly Cares.
Medicare pays Kisunla under coverage with evidence development: no manufacturer program reaches a Medicare patient's coinsurance, and registry enrollment is a claim requirement alongside a clinical one. A Medigap plan is the only route to $0 on Medicare. See every program for this patient, with current status →
Original Medicare allows $2,996.64 for the 1,400 mg maintenance dose plus the 96365 infusion code, and the patient's 20% coinsurance is $599.33 once the Part B deductible is met. A Medigap plan can take that to $0. What each Medigap plan leaves on this claim ↓
$4.185 per 2 mg for Q4 2026 (ASP+6%). At the 1,400 mg maintenance dose that's 700 billing units, so Medicare's allowed drug amount is $2,929.50.
No. The Kisunla Savings Card Program covers the drug cost only, down to $0 per infusion on a commercial plan, up to $9,450 a year; the 96365 administration charge is billed separately and isn't part of the card. See every program for this patient →
Each 350 mg single-dose vial is 175 billing units of J0175, or $732.38 at the Q4 2026 ASP+6% rate of $4.185 per 2 mg. The maintenance dose uses four vials for 1,400 mg.
No: Lilly's commercial savings program excludes federal plans, so Medicare, Medicaid and other government program patients don't qualify, and there's no manufacturer coinsurance-assistance program for Kisunla on Medicare. A Medigap plan is what brings the coinsurance to $0; Medicare pays Kisunla under coverage with evidence development, which requires registry enrollment. Full explanation: what every plan letter A–N covers →
The titration schedule starts lower: infusion 1 (350 mg) is $146.48 drug coinsurance plus the $13.43 infusion line, for $159.91; infusion 2 (700 mg) is $292.95 plus $13.43; infusion 3 (1,050 mg) is $439.43 plus $13.43. Infusion 4 and beyond, the 1,400 mg maintenance dose, is $599.33 total. See the estimate above ↑
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; 36 commercial payer published price files (Q2 2026); Kisunla Savings Card Program and Lilly Cares Foundation Patient Assistance terms (kisunla.lilly.com/support-resources, verified Apr 11, 2026).
Reviewed September 20, 2026 by Erin Rose, CareCost Estimate founder. Methodology →