Leqvio (inclisiran) cost per injection and what the patient owes

$12.897 per mg is Part B's ASP+6% rate for Q4 2026. Once the $283 Part B deductible is met, the patient owes a flat 20% coinsurance on the drug and its administration, with no annual out-of-pocket maximum to cap it. Full explanation: How Medicare Part B drug cost sharing works →

Medicare pays J1306 per 1 mg billing unit, not per syringe or per dose. Because Leqvio's label dose is a flat 284 mg for every indication, the allowed drug amount is the same $3,662.75 every time — there is no weight-based variation to price, unlike a mg/kg-dosed infused drug.

Leqvio is not a flat twice-a-year drug from day one. The first year runs three doses: day 0, month 3 and month 9. After that the schedule drops to two doses a year, six months apart. Multiplying the per-visit total above ($3,678.11 allowed, $735.62 owed once the deductible is met) by the dose count for each year gives the annual totals below.

$3,678.11 × 3 = $11,034.33 and $735.62 × 3 = $2,206.86 for year one; $3,678.11 × 2 = $7,356.22 and $735.62 × 2 = $1,471.24 for a maintenance year. Both totals assume the $283 Part B deductible is already met on every visit, the same reference-patient assumption the estimator uses throughout. A patient who has not met it pays the deductible once, on whichever dose lands first in the plan year, not on every dose. A missed dose changes the schedule and the claim dates: less than 3 months late, give it and keep the original schedule; more than 3 months late, restart with a new initial dose, a dose at 3 months, then every 6 months.

For the reference patient — 284 mg, 284 units, drug + the 96372 administration code — Medicare allows $3,678.11, and the Part B coinsurance on that is $735.62. Plans A, B, C, D, F, G, M and N cover that coinsurance in full, so those patients owe nothing per dose once the $283 deductible is met. Plans K and L do not, and for them the deductible decides which dose costs more. The first dose of the calendar year, before the deductible is met, costs a Plan K patient $622.52; each later dose that year costs $367.82. The doses do not cost the same: a maintenance year has one of each, and a first year with the deductible unmet at day 0 has one at the higher figure and up to two at the lower. See what each Medigap plan (A–N) owes on this claim →

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 J1306, not ASP+6% — our corpus holds published rates from 36 payers, including Aetna, UnitedHealthcare, Cigna, Anthem, Regence, Premera and Kaiser. Aetna’s median is $12.91 per mg against Medicare’s $12.897, putting a 284 mg dose at $3,666.44 before benefits. Rates move by state as well as by payer, which is why the estimator above takes one. What the patient owes then depends on their specific benefits. Full explanation: How commercial drug reimbursement works →

Medicare pays the same ASP+6% rate for the Leqvio drug itself no matter where it's given. Leqvio is a short in-office subcutaneous injection, not an infusion, so most claims bill under the physician fee schedule's injection code (96372) rather than a hospital-outpatient facility fee. Some commercial payers apply a site-of-care rule to inclisiran: 9 of the 28 policy sets in our coverage corpus carry one. Seven place Leqvio under a site-of-care or site-of-service review, Highmark treats it as outpatient unless special circumstances apply, and BCBS Massachusetts covers it only under the pharmacy benefit. Our data doesn't carry a Leqvio-specific hospital-outpatient facility rate, so this estimator only prices the office/physician-fee-schedule path.

Place of service (POS) is what drives that rate split. POS 11 (office) prices the admin code at the non-facility physician fee schedule rate, which is the path this estimator prices. A site-of-care rule that sends the same claim to POS 19 (off-campus hospital outpatient), POS 22 (hospital outpatient) or POS 24 (ambulatory surgical center) moves the admin code to the facility rate instead — a different number for the same CPT code. Confirm the POS on the claim before comparing an admin-fee estimate against what a payer actually paid.

The rate has moved from $12.277 per mg in 2025 Q1 to $12.897 per mg for the current quarter, from $3,486.67 to $3,662.75 on a 284 mg dose. Use the quarter that is actually in effect for the claim's date of service.

On a commercial plan, the LEQVIO Co-Pay Card can take the drug copay down to $0 per dose, up to $3,000 per treatment and $3,600 a year (as of April 9, 2026). The card covers the drug cost only: on a commercial claim it applies to the patient’s share of the J1306 line, while the share of the 96372 administration code and any separate office visit stays with the patient. It excludes Medicare, Medicaid and other government insurance.

Uninsured patients have a manufacturer route: the Novartis Patient Assistance Foundation ships Leqvio free to the provider, with no claim filed for the drug, under an income limit of 250–500% of the federal poverty level depending on household size (as of April 9, 2026). On Medicare, no manufacturer program touches the coinsurance; a diagnosis-matched foundation fund is the only path, when one is open. The PAN Foundation’s hypercholesterolemia fund is open, up to $3,800 a year (checked August 2, 2026), but it lists only familial hypercholesterolemia codes, so it matches HeFH billed as E78.011 or HoFH billed as E78.010, and not primary hypercholesterolemia on E78.00. HealthWell Foundation’s Medicare-access fund, which lists E78.00, is closed (checked June 11, 2026). See every program for this patient, with current status →

Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (96372, national non-facility); Medicare Part B deductible (2026); Medicare Rights Center 2026 Medigap plan benefits chart; 36 commercial payer published price files (Q2 2026); LEQVIO Co-Pay Card and Novartis Patient Assistance Foundation terms and status (public/programs-bundle.js, generated from the live programs corpus).

Reviewed September 22, 2026 by Erin Rose, CareCost Estimate founder. Methodology →