Quick Answer: In 2026, Leqembi (lecanemab) costs about $26,500 to $29,400 per year at list price, billed as biweekly IV infusions under HCPCS code J0174. Kisunla (donanemab) costs about $32,000 per year at list price, billed as monthly IV infusions under HCPCS code J0175, though its fixed-duration dosing means many patients finish treatment and stop paying within 12 to 18 months. Medicare Part B covers both drugs for patients with confirmed amyloid pathology and mild cognitive impairment or mild Alzheimer's dementia, enrolled in a CMS-approved registry; beneficiaries owe 20% coinsurance after the 2026 Part B deductible of $283, with no annual out-of-pocket cap under Original Medicare unless they carry a Medigap policy. Neither drug is currently subject to Inflation Reduction Act price negotiation because both are too new; Eisai and Eli Lilly each run a manufacturer patient assistance program for uninsured and underinsured patients, but federal anti-kickback law blocks their commercial copay cards for anyone on Medicare, Medicaid, TRICARE, or VA benefits.
Leqembi and Kisunla are the two anti-amyloid monoclonal antibody infusions approved by the FDA for early Alzheimer's disease as of 2026. Eisai and Biogen co-market Leqembi (lecanemab-irmb), which received full FDA approval on July 6, 2023, and is billed under HCPCS code J0174 per milligram. Eli Lilly markets Kisunla (donanemab-azbt), approved July 2, 2024, and billed under HCPCS code J0175. Both drugs work by clearing amyloid-beta plaques from the brain and are approved only for patients with mild cognitive impairment or mild dementia stage Alzheimer's disease, not moderate or severe disease. Unlike an oral pill picked up at a pharmacy counter with a Medicare Part D formulary tier and copay, both drugs are physician-administered infusions billed to Medicare Part B, so no formulary tier or Part D deductible applies to either one.
Leqembi is dosed at 10 mg/kg by IV infusion every two weeks, so its annual list price scales with body weight and runs roughly $26,500 to $29,400 in 2026 for most adults. Kisunla uses a flat, weight-independent dose given by IV infusion every four weeks, with a list price near $32,000 per year. The key financial difference is duration: Leqembi is currently approved for ongoing use, while Kisunla is a fixed-duration therapy, meaning a brain amyloid PET scan can show the plaques have cleared and treatment can stop, often within 12 to 18 months, which lowers the real-world average annual cost well below the full list price for many patients.
Neither Leqembi nor Kisunla appears on either round of Medicare drug price negotiation under the Inflation Reduction Act. The statute only allows CMS to select small-molecule drugs that have been on the market at least 7 years, or biologics on the market at least 11 years, before Medicare can negotiate a Maximum Fair Price. Leqembi and Kisunla will not be eligible for negotiation consideration until the early 2030s at the soonest. Patients struggling with the coinsurance should check Medicare eligibility rules for their situation and confirm whether a Medigap policy or their state's Medicaid income limits could eliminate the 20% coinsurance entirely.
What Leqembi & Kisunla Costs by Point of Pay (2026)
The price you pay depends almost entirely on WHERE you pay. The same leqembi & kisunla can cost many times more at a hospital than at your local pharmacy:
2026 Leqembi & Kisunla Price by Point of Pay| Where you pay | Typical cost | Notes |
|---|
| Medicare ASP rate (Part B, 2026) | ASP + 6%: ~$1.36/mg Leqembi, ~$2.03/mg Kisunla | Medicare's payment limit to the infusing provider; updated quarterly by CMS |
| Medicare Part B beneficiary coinsurance | 20% after the $283 Part B deductible (2026) | No annual out-of-pocket cap under Original Medicare; Medigap can cover the coinsurance |
| Medicare Advantage | 20% coinsurance up to the plan's annual out-of-pocket max | 2026 in-network MOOP is capped at $9,250 by CMS; prior authorization is standard |
| Commercial insurance (with copay card) | $0/infusion up to program caps ($10,000/year Leqembi; $9,450/year Kisunla) | Commercial coverage only; excludes government-insured patients by federal law |
| Medicaid | $0 - $4/infusion visit, with prior authorization | Coverage and biomarker-testing rules vary by state Medicaid program |
ASP figures reflect CMS Medicare Part B Drug Pricing files and manufacturer list prices for 2026. Actual coinsurance depends on your plan, site of care, and whether you have supplemental coverage.
Source: CMS Medicare Part B Drug Pricing files 2026, CMS Medicare Advantage MOOP calculation, Eisai and Eli Lilly patient support programs
Why Hospitals Charge So Much
Hospital outpatient infusion centers routinely charge more than independent neurology infusion suites for the same Leqembi or Kisunla dose because hospitals add a facility fee on top of the drug acquisition cost and the infusion administration CPT code. A single Leqembi or Kisunla infusion billed at a hospital outpatient department can run several hundred dollars higher than the identical infusion at a freestanding specialty infusion clinic, even though Medicare reimburses the drug itself at the same ASP-based rate everywhere.
Patients undergoing Leqembi or Kisunla treatment also face separate charges for amyloid PET scans, cerebrospinal fluid testing, and MRI monitoring for ARIA (amyloid-related imaging abnormalities), a required safety check every few infusions. These diagnostic and monitoring services are billed under their own CPT codes, entirely separate from the J0174 or J0175 drug charge, and can add $1,000 to $5,000 per year depending on how often MRIs are ordered and whether PET or CSF testing was used to confirm amyloid pathology at the start of treatment.
HCPCS J-Codes: What Appears on Your Bill
Leqembi and Kisunla each have a distinct HCPCS Level II J-code used for Medicare Part B billing. Confirm the correct code matches your prescribed drug before paying an unexpected bill.
HCPCS J-codes for Leqembi & Kisunla| Code | Description | What to look for |
|---|
| J0174 | Injection, lecanemab-irmb (Leqembi), 1 mg | Billed roughly every 2 weeks at 10 mg/kg. A 70 kg patient's dose is 700 mg per infusion; verify the mg count on your Explanation of Benefits matches your weight-based dose. |
| J0175 | Injection, donanemab-azbt (Kisunla), 2 mg | Billed monthly with a titration schedule (700 mg for the first three doses, then 1,400 mg). Confirm your bill reflects the correct titration stage, not a flat 1,400 mg from the first infusion. |
J-codes are separate from the CPT administration code (typically 96413/96415 for IV infusion) and from any PET, CSF, or MRI monitoring codes, which appear as separate line items.
Source: CMS HCPCS Level II code set 2026
Patient Assistance Programs
Eisai (Leqembi) and Eli Lilly (Kisunla) each run a manufacturer copay assistance program for commercially insured patients and a separate patient assistance program for uninsured or financially burdened patients. Without insurance, the manufacturer coupon plus patient assistance program is generally your only realistic path to affording either drug at its $26,500 to $32,000 annual list price.
Patient assistance programs for Leqembi & Kisunla| Manufacturer program | Cost / Benefit | How to apply |
|---|
| LEQEMBI Copay Assistance Program (Eisai) | As low as $0 per infusion, up to $10,000 per calendar year, for commercially insured patients | eisaipatientsupport.com/patient/leqembi |
| LEQEMBI Patient Assistance Program (Eisai Companion) | Free Leqembi for uninsured, income-qualifying patients enrolled for a rolling 12-month period | eisaipatientsupport.com/patient/leqembi |
| Kisunla Complete Savings Card (Eli Lilly) | $0 copay per infusion, up to 15 infusions and $9,450 in savings per calendar year, for commercially insured patients | kisunla.lilly.com |
| Lilly Cares Foundation Patient Assistance Program | Free Kisunla for uninsured or underinsured patients at or below approximately 400% of the federal poverty level | lillycares.com |
Both manufacturer copay cards explicitly exclude patients with Medicare, Medicaid, TRICARE, or VA coverage, because federal anti-kickback law (42 U.S.C. Section 1320a-7b) bars drugmakers from subsidizing copays for government-insured beneficiaries. If you have Medicare Part B, the copay card will not work at the infusion center; instead, ask about the income-based patient assistance program, a Medigap policy to cover the 20% coinsurance, or your state's Medicaid income limits if you qualify for dual coverage.
Source: Eisai Patient Support (eisaipatientsupport.com), Lilly Cares Foundation (lillycares.com)
Common Leqembi & Kisunla Billing Errors
If your Leqembi or Kisunla bill looks higher than expected, check for these common billing issues before paying:
- Registry enrollment not documented: Medicare requires enrollment in a CMS-approved outcomes registry as a condition of coverage. If your provider's office never enrolled you, Medicare can deny the entire claim retroactively.
- Missing amyloid biomarker confirmation on the claim (PET scan or CSF test). Without documented amyloid pathology, Medicare and most commercial plans deny the drug claim outright.
- Kisunla billed at the full 1,400 mg maintenance dose from the first infusion instead of the required 700 mg titration doses for the first three infusions, which overcharges the drug line by roughly double.
- Hospital outpatient facility fee stacked on top of the drug charge when the same infusion is available at a freestanding infusion clinic for hundreds of dollars less. Ask your neurologist's office whether a non-hospital infusion site is available.
- Manufacturer copay card rejected without explanation, most often because the claim was submitted under Medicare or Medicaid, which are ineligible for the commercial copay card by federal law.
- MRI monitoring for ARIA billed as a separate, uncoordinated visit with its own facility fee, instead of being scheduled alongside a covered infusion visit to reduce total visits and copays.
Frequently Asked Questions
Is there a generic or biosimilar for Leqembi or Kisunla?
No. As of 2026, no generic or biosimilar exists for either drug. Leqembi (approved July 2023) and Kisunla (approved July 2024) are both protected by 12 years of FDA biologics exclusivity plus manufacturer patents, so no biosimilar competition is expected before the mid-2030s at the earliest. Patients pay the full manufacturer list price, a Medicare Part B coinsurance share, or an insurance copay, since generic substitution is not an option.
How do I apply for the Leqembi or Kisunla patient assistance program?
Call Eisai Patient Support at 1-833-453-7362 for Leqembi or Lilly Cares at 1-800-545-6962 for Kisunla, or start online at eisaipatientsupport.com/patient/leqembi or lillycares.com. Your neurologist completes the prescriber section, and you submit proof of income, US residency, insurance status, and your prescription. Approved patients typically receive the drug shipped directly to their infusion provider at no cost, with annual recertification required.
Can I use the Leqembi or Kisunla savings card with Medicare?
No. Federal anti-kickback law (42 U.S.C. Section 1320a-7b) bars manufacturer copay cards from being used by anyone with Medicare, Medicaid, TRICARE, or VA benefits. The LEQEMBI Copay Assistance Program and the Kisunla Complete Savings Card are for commercially insured patients only. If you have Medicare Part B, apply for the income-based patient assistance program instead, or ask about a Medigap policy to cover your 20% coinsurance.
What if my insurance denies coverage for Leqembi or Kisunla?
Request the written denial notice and identify the reason, most often missing amyloid biomarker documentation or registry enrollment. Have your neurologist submit the missing PET scan, CSF test, or registry confirmation and file a formal appeal within 60 days for Medicare or up to 180 days for most commercial plans. If denied again, request a peer-to-peer review, then escalate to an independent external review. If appeals fail, apply for the manufacturer's patient assistance program as a fallback.
Does the IRA negotiated Medicare price apply to Leqembi or Kisunla?
No. Neither drug has been selected for Medicare price negotiation under the Inflation Reduction Act. Biologics only become eligible for negotiation once they have been on the market at least 11 years, so Leqembi (approved 2023) and Kisunla (approved 2024) will not be eligible until the early 2030s at the soonest. Medicare beneficiaries instead pay standard 20% Part B coinsurance, which has no annual cap under Original Medicare unless you carry a Medigap policy.
What does Leqembi or Kisunla cost without insurance at the infusion center in 2026?
Without insurance, Leqembi runs about $26,500 to $29,400 per year in list price for biweekly infusions, while Kisunla runs about $32,000 per year for monthly infusions, both before facility fees. A freestanding infusion clinic typically charges close to the wholesale acquisition cost of $26,500 to $32,000 per year, while a hospital outpatient infusion center can push the total to $32,000 to $68,000 per year once facility fees are added.
Do I qualify for the Leqembi or Kisunla patient assistance program?
You generally qualify if you are uninsured or underinsured, a US resident, have a valid prescription and confirmed amyloid pathology, and your household income falls at or below approximately 400% of the federal poverty level, which is $63,840 for a household of one and $132,000 for a household of four in 2026. Both Eisai and Lilly Cares review applications individually, so call the program directly if your income is close to the threshold.
What is the difference between Leqembi and Kisunla?
Leqembi (lecanemab) is dosed by body weight, given every two weeks, and is currently approved for ongoing use with no defined stopping point. Kisunla (donanemab) uses a flat dose, given every four weeks, and is a fixed-duration therapy, meaning treatment can stop once a repeat amyloid PET scan shows the plaques have cleared, often within 12 to 18 months. Both require the same amyloid biomarker confirmation, ApoE4 genetic risk discussion, and periodic MRI monitoring for ARIA, and both are billed under Medicare Part B rather than Part D.
