Monoferric (J1437) cost and reimbursement per dose

$21.077 per 10 mg unit is Part B's ASP+6% rate for Q3 2026 ($2.1077 per mg). Medicare pays J1437 per 10 mg billing unit — a 1,000 mg dose is 100 units, not 1,000: billing 1,000 units for a 1,000 mg dose over-bills the claim tenfold ($21,077.00 against the correct $2,107.70). On the default 1,000 mg dose that is $2,107.70 for the drug, and the administration line (96365, $67.14) is only 3.1% of the $2,174.84 allowed amount — nowhere near the near-even split on a cheaper iron. The infusion (96365–96366) code page carries the full definition; Monoferric has no push route, so 96374 does not apply here, the opposite of Injectafer. Full explanation: How Medicare Part B drug cost sharing works →

What changes under 50 kg

Patients under 50 kg are dosed by weight instead of the flat 1,000 mg: 20 mg/kg actual body weight, still a single infusion, capped at the 1,000 mg flat dose. A 45 kg patient needs 900 mg — 90 units:

That patient's 20% coinsurance is $392.81, less than the $434.97 owed on the flat 1,000 mg visit above, because it is a smaller dose. There is no two-dose course on this label the way there is on Injectafer: one infusion completes treatment at any weight, repeated only if the iron deficiency anemia recurs.

Iron-deficiency anemia and the non-dialysis CKD indication both dose the same way on this label — 1,000 mg as a single intravenous infusion for a patient 50 kg and over, or 20 mg/kg actual body weight under 50 kg — so the estimator's 1,000 mg default prices either diagnosis without a separate setting. Those are the only two regimens on the label: no course, no push route, and no heart-failure or pediatric indication the way there is on Injectafer, whose weight-and-hemoglobin dosing table and 96374 push code do not apply here.

Repeat dosing is not scheduled at all — the label allows a second dose only if iron deficiency anemia recurs, at whatever interval the patient's labs call for. Prior authorizations in the Clearance corpus are written per dose rather than per course: BCBS Kansas, BCBS Minnesota and Capital BlueCross cap J1437 at 100 billing units (1,000 mg) per 35 days, and Cigna at 1,000 mg per 30 days.

For a 1,000 mg dose with the 96365 IV infusion administration code, Medicare allows $2,174.84, and the Part B coinsurance on that is $434.97. 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; Plan K leaves $217.48 and Plan L $108.75. The under-50 kg dose has its own, smaller coinsurance: a 45 kg patient's 900 mg dose allows $1,964.07, so 20% of it is $392.81 — less than the $434.97 owed on a 1,000 mg visit, the same smaller-dose-for-a-smaller-patient trade as the table above.

A single Monoferric visit ($2,174.84) is more than seven times the $283 Part B deductible, so the deductible is a one-time partial hit rather than a recurring one. Whichever visit happens to land before the deductible is met absorbs the full $283 plus 20% of the remaining $1,891.84 ($378.37), for $661.37 on that visit; every other visit in the year is a plain $434.97 coinsurance. There is no second visit on this label the way there is on Injectafer's two-dose course — one infusion completes treatment at any weight 50 kg and over, repeated only if the anemia recurs.

That is why the month a claim happens still matters here, even though the claim itself is large enough that Medigap coverage, not the deductible, decides most of what full-coverage-plan patients owe. 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 J1437, not ASP+6% — Aetna's median published rate across the corpus is $2.30 per mg ($23.00 per 10 mg unit), putting a 1,000 mg dose at $2,300.00 before benefits. Full explanation: How commercial drug reimbursement works →

Priced per 1,000 mg of elemental iron at Q3 2026 ASP+6%, Monoferric is the most expensive iron in the class — the question worth asking is what that price buys back in visits:

A 12x spread separates the cheapest and most expensive products in this class for the same 1,000 mg of iron, and Monoferric sits at the very top of it: 9.3x Venofer's price and 1.9x Injectafer's for the same iron. What the price buys back is visits: Venofer's labeled course for that same 1,000 mg is five separate 200 mg doses, each with its own administration line, for a total of $415.70 allowed. Matched to that same 1,000 mg, Injectafer's single-dose alternative allows $1,169.74 in one visit.

Monoferric's full 1,000 mg dose allows $2,174.84 in one visit — $1,005.10 more than Injectafer's single dose for the same iron in the same single visit, and $1,759.14 more than Venofer's five-visit course. What that buys is one vial, one 20-minute infusion, no push, no second visit and no weight math above 50 kg.

9 of the 15 payers in this corpus make a patient fail another IV iron before they pay for Monoferric; BCBS Kansas requires failure on two named products first. See how each payer writes that rule → These figures are Medicare allowed amounts only, not a clinical recommendation; no product in this table is more or less clinically right for a given patient because of its price.

Pharmacosmos Therapeutics runs the Monoferric Patient Solutions Co-pay Program for commercially insured patients: the program pays the drug down to $0 per dose, up to $2,000 per treatment and $4,000 per calendar year. It covers the drug only — the $67.14 96365 charge is billed and owed separately, so a commercial patient using the card still sees an administration line the card does not touch (20% of it is $13.43). Medicare, Medicaid and other government-plan patients are excluded from the card entirely; a separate Monoferric Patient Solutions program ships free drug to uninsured patients or those in a coverage gap. See the full program terms →

This page's reference patient bills D50.9, unspecified iron deficiency anemia; the chart may instead document D50.0 or D50.8 for the same oral-iron-failure indication, whichever fits. The non-dialysis CKD indication bills D63.1 (anemia in chronic kidney disease), paired with a CKD stage or dialysis-status code from N18.30 through N18.5. Unlike Injectafer, this label carries no heart-failure indication and no I50 code at all.

A three-character iron-deficiency-anemia category code by itself is not billable — D50 needs the added digit that makes it D50.0, D50.8 or D50.9.