Rituxan (rituximab) cost per infusion and what the patient owes

Medicare Part B pays for Rituxan at ASP+6% — $72.094 per 10 mg billing unit for Q4 2026. Once the $283 Part B deductible is met, the patient owes the remaining 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 →

How the RA and pemphigus vulgaris doses draw without waste

Rituximab ships in 100 mg/10 mL and 500 mg/50 mL single-dose vials. The rheumatology doses are flat milligram amounts, not scaled to weight, and both of the common ones draw cleanly from that vial set: a 1,000 mg infusion — rheumatoid arthritis or the first two pemphigus vulgaris infusions — is two 500 mg vials, and the 500 mg maintenance dose used later in granulomatosis with polyangiitis, microscopic polyangiitis and pemphigus vulgaris is one 500 mg vial. Nothing is drawn and left over on either dose, so the claim carries the JZ modifier for no discarded drug rather than JW.

Because both doses fill vials exactly, the coinsurance jumps that show up on a weight-dosed biologic don’t apply here: the 1,000 mg patient owes exactly double the 500 mg patient, no more. The granulomatosis-with-polyangiitis induction dose — 375 mg/m² weekly for four weeks — is calculated from body surface area rather than a flat milligram amount, so it is not priced on this page; work out the patient-specific milligrams first, then use the estimator above. How the units and the JZ line are built →

For the reference patient on the rheumatoid-arthritis schedule — a 1,000 mg infusion, 100 units, drug + both infusion codes — Medicare allows $7,427.84, and the Part B coinsurance on that is $1,485.56. Plans A, B, C, D, F, G, M and N cover Part B coinsurance in full, so after the deductible they leave a Rituxan patient nothing to pay at the chair. Plans K and L are the exceptions. Because the rheumatoid-arthritis dose is the same flat 1,000 mg for every patient rather than scaled to weight, the $742.79 Plan K figure below is not patient-specific — it recurs at each 1,000 mg infusion in the course, two infusions two weeks apart, repeated every 24 weeks (not sooner than 16) with methotrexate. 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 J9312, not ASP+6% — our corpus holds published rates from 37 payers, including Aetna, UnitedHealthcare, Cigna, Anthem, Regence, Premera and Kaiser. Aetna’s all-states median is $76.25 per 10 mg unit against Medicare’s $72.094, putting the 1,000 mg rheumatoid-arthritis dose at $7,625.00 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 →

The same 1,000 mg rheumatoid-arthritis dose used in the worked example above is billed under four different HCPCS codes depending on which intravenous rituximab product is ordered, and the allowed amount spans more than 12-fold between them. The subcutaneous product, Rituxan Hycela, is listed last for reference: it carries its own code and its own fixed doses and cannot be substituted for an IV order. Rituxan Hycela is the same molecule given subcutaneously with hyaluronidase, in the manufacturer’s own fixed doses, and is not interchangeable with an IV order.

21 of the 25 payers in CareCost’s coverage corpus carry a preferred-product rule that puts a biosimilar ahead of Rituxan, and several require two of Truxima, Ruxience and Riabni to fail first — the spread above is why. Full explanation: preferred-product and step-therapy rules by payer →

Medicare pays the same ASP+6% rate for the Rituxan drug itself no matter where it's infused. The difference is what gets billed alongside it: an office infusion bills the physician fee schedule's administration codes (96413/96415) and, when documented, a separate office visit (99214) — the codes used in the estimator above — while a hospital outpatient department bills its own facility fee under the hospital outpatient prospective payment system instead of those physician-fee-schedule codes. Our data doesn't carry a Rituxan-specific hospital-outpatient facility rate, so this estimator only prices the office/physician-fee-schedule path.

The rate has fallen in every quarter since 2025 Q1, from $76.73 to the current $72.094 — a drop of 6.0% over eight quarters.

On a commercial plan, the Genentech Co-pay Assistance Program brings the patient responsibility for both the drug and its administration down to $5 each, up to $25,000 a year — on a commercial plan whose patient responsibility runs near the $1,485.56 of the Medicare example above, that is the difference between that responsibility and $10.

On Medicare that program does not apply at all: it excludes Medicare, Medicaid and other government coverage by design, and no foundation fund on file is open for rheumatoid arthritis today. Granulomatosis with polyangiitis and microscopic polyangiitis are different — HealthWell’s ANCA-associated vasculitis and granulomatosis with polyangiitis fund is open and fits both. See every program for this patient, with current status →

Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (96413, 96415, 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); Genentech Co-pay Assistance Program and foundation fund terms and status (public/programs-bundle.js, generated from the live programs corpus).

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